Clinico-biological characteristics and outcome of hepatitis C virus-positive patients with diffuse large B-cell lymphoma treated with immunochemotherapy

Abstract

Diffuse large B cell lymphoma (DLBCL) patients carrying hepatitis C virus (HCV) have higher risk of treatment toxicity and complications. The aim of this study was to assess the impact of HCV in a series of DLBCL patients treated with immunochemotherapy. 321 patients (161 M/160F; median age, 66 years) diagnosed with de novo DLBCL in a single center between 2002 and 2013 were included. Immunodeficiency-related lymphomas were excluded. HCV+ cases were defined by the presence of IgG anti-HCV. Main clinico-biological characteristics and outcome were analyzed according to the viral status. Two hundred ninety patients were HCV- and 31 HCV+. HCV+ patients were older (median age 71 vs. 64 years, P = 0.03), had more often B symptoms (P = 0.013), spleen (P = 0.003), and liver (P = 0.011) involvement, higher rate of early death (<4 months, P = .001), and shorter overall survival (OS). Eleven HCV+ patients had cirrhosis criteria. HCV+ patients with impaired liver function before or during treatment showed inferior OS. Elevated pre-treatment bilirubin correlated also with higher liver toxicity. In a multivariate analysis that included R-IPI score, serum beta2-microglobulin (β2m), HCV status, and presence of cirrhosis, only R-IPI, β2m, and cirrhosis showed independent prognostic impact on OS. The presence of HCV in DLBCL patients entails higher number of complications and early deaths; however, liver impairment and not the hepatitis viral status was the key feature in the outcome of the patients.

Lymphomas associated with chronic hepatitis C virus infection: A prospective multicenter cohort study from the Rete Ematologica Lombarda (REL) clinical network

“…cial point for the outcome of patients with DLBCL in chronic HCV infection, as also recently confirmed by Dlouhy et al29 Moreover,…”

“…In aggressive lymphoma, it is more frequent, with respect to indolent subtypes, the coexistence of a more advanced liver disease; 75% of our cases of cirrhosis are among aggressive lymphoma. This is a crucial point for the outcome of patients with DLBCL in chronic HCV infection, as also recently confirmed by Dlouhy et al Moreover, the percentage of patients experiencing liver toxicity and/or interrupting (immuno‐) chemotherapy is significant: 41 (22%) patients developed liver toxicity of any grade (grade 3‐4 in nearly half of them) and 19 patients interrupted early the treatment (for severe liver toxicity in nine). In a previous report focused on HCV‐associated DLBCL, 14% experienced severe hepatotoxicity .…”

Hepatitis C virus infection is an independent prognostic factor in follicular lymphoma

“…On the other hand, it has been reported that HCV-positive DLBCL is characterized by the common involvement of the spleen and liver [ 9 ]. Also, it is more common in the elderly and B symptoms are common; it is also characterized by elevated lactate dehydrogenase (LDH) levels, poor international prognostic index, and involves more than one extranodal site [ 10 – 13 ]. There is a higher incidence of liver damage during chemotherapy, although there is no difference in the overall survival (OS) and progression-free survival (PFS) of DLBCL [ 12 ].…”

“…Specifically, while the characteristics of HCV-positive SMZL [ 8 ] and HCV-positive DLBCL [ 10 – 13 ] have been reported, there has been no report detailing the clinicopathological characteristics of patients with HCV- positive FL. This study analyzes the clinicopathological characteristics of patients with FL based on HCV status.…”

Clinical characteristics and outcomes for HIV-associated Diffuse Large B-cell Lymphoma in China: A retrospective single-center study

“…In HIV negative DLBCL, HBsAg-positive patients have worse clinical features and poor outcomes and the presence of HCV revealed inferior OS when companied with impaired liver function [11,37];…”