Efficacy and prognosis of antiviral therapy on hepatitis C following treatment of lymphoma in HCV-positive diffuse large-cell lymphoma

Tsutsumi, Yutaka; Nakayama, Chie; Kamada, Koki; Kikuchi, Ryô; Kudo, Daiki; S, Itó; Matsuoka, Satoshi; Shiratori, Souichi; Yamamoto, Yoshiya; Naruse, Hirohito; Teshima, Takanori

doi:10.1007/s00277-017-3129-0

Cited by 13 publications

(9 citation statements)

References 18 publications

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“…Only one patient developed a severe late liver-related event (HCC, successfully treated), and no patient died due to hepatic failure. In line with our results, a recent Japanese report showed no recurrence or death at 2 years in five patients with genotype 2 HCV-positive DLBCL treated sequentially with SOF + RBV after achievement of CR with I-CT [30].…”

Section: Discussionsupporting

confidence: 92%

Direct-Acting Antivirals in Hepatitis C Virus-Associated Diffuse Large B-cell Lymphomas

et al. 2018

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Background International guidelines suggest hepatitis C virus (HCV) eradication by direct‐acting antivirals (DAAs) after first‐line immunochemotherapy (I‐CT) in patients with HCV‐positive diffuse large B‐cell lymphoma (DLBCL), although limited experiences substantiate this recommendation. Moreover, only a few data concerning concurrent administration of DAAs with I‐CT have been reported. Subjects, Materials, and Methods We analyzed hematological and virological outcome and survival of 47 consecutive patients with HCV‐positive DLBCL treated at 23 Italian and French centers with DAAs either concurrently (concurrent cohort [ConC]: n = 9) or subsequently (sequential cohort [SeqC]: n = 38) to first‐line I‐CT (mainly rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone [R‐CHOP]‐like). Results Median age was 61 years, 89% of patients had stage III/IV, and 25% presented evidence of cirrhosis. Genotype was 1 in 56% and 2 in 34% of cases. Overall, 46 of 47 patients obtained complete response to I‐CT. All patients received appropriate DAAs according to genotype, mainly sofosbuvir‐based regimens (n = 45). Overall, 45 patients (96%) achieved sustained virological response, 8 of 9 in ConC and 37 of 38 in SeqC. DAAs were well tolerated, with only 11 patients experiencing grade 1–2 adverse events. Twenty‐three patients experienced hepatic toxicity (grade 3–4 in seven) following I‐CT in SeqC, compared to only one patient in ConC. At a median follow‐up of 2.8 years, two patients died (2‐year overall survival, 97.4%) and three progressed (2‐year progression‐free survival, 93.1%). Conclusion Excellent outcome of this cohort of HCV‐positive DLBCL suggests benefit of HCV eradication by DAAs either after or during I‐CT. Moreover, concurrent DAAs and R‐CHOP administration appeared feasible, effective, and ideally preferable to deferred administration of DAAs for the prevention of hepatic toxicity. Implications for Practice Hepatitis C virus (HCV)‐associated diffuse large B‐cell lymphomas (DLBCLs) represent a great therapeutic challenge, especially in terms of hepatic toxicity during immune‐chemotherapy (I‐CT) and long‐term hepatic complications. The advent of highly effective and toxicity‐free direct‐acting antivirals (DAAs) created an exciting opportunity to easily eradicate HCV shortly after or in concomitance with first‐line immunochemotherapy (usually R‐CHOP). This retrospective international study reports the real‐life use of the combination of these two therapeutic modalities either in the concurrent or sequential approach (DAAs after I‐CT) in 47 patients. The favorable reported results on long‐term outcome seem to support the eradication of HCV with DAAs in all patients with HCV‐positive DLBCL. Moreover, the results from the concurrent approach were effective and safe and displayed an advantage in preventing hepatic toxicity during I‐CT.

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Section: Discussionsupporting

confidence: 92%

Direct-Acting Antivirals in Hepatitis C Virus-Associated Diffuse Large B-cell Lymphomas

et al. 2018

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“…Rituximab alone or combined with antivirals and/or chemotherapy yielded good outcomes in low‐grade B‐NH L . The availability of IFN‐free protocols using DAAs providing high virological efficacy and no hematological toxicity should permit them to be used successfully with chemotherapy, taking into account possible drug‐drug interactions between the agents …”

Section: B‐cell Lymphoproliferative Diseasesmentioning

confidence: 99%

Considering hepatitis C virus infection as a systemic disease

Cacoub

Comarmond

2018

Seminars in Dialysis

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Hepatitis C virus (HCV) infection has been demonstrated to result in several adverse hepatic outcomes and has been associated with a number of important extrahepatic manifestations. The scope of extrahepatic clinical possibilities includes systemic diseases such as vasculitis and lymphoproliferative disorders, cardiovascular disease, myalgia, arthritis, and sicca syndrome. These end-organ effects of HCV may dominate the clinical course beyond the hepatic complications and significantly worsen the longterm prognosis of infected patients. Until several years ago, the standard of care for the treatment of HCV infection had been interferon-alpha-based regimens, which not only had limited effectiveness in achieving a cure but were often poorly tolerated, especially in patients with kidney disease. In those HCV-infected patients with significant systemic manifestations, the interferon-based regimens were problematic given their association with a wide variety of toxicities. The development of highly effective direct-acting antiviral agents to treat HCV infection presented an opportunity to improve the HCV care cascade with the eradication of HCV in most infected patients and by reducing the burden of both hepatic and extrahepatic complications.

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“…Antiviral therapy with interferon and ribavirin is able to induce a 70–75% response rate in patients with HCV-associated low-grade NHL who do not need immediate conventional treatment [ 99 ]. It is possible that a better prognosis could be achieved by performing HCV antiviral therapy after achieving remission in the cases of HCV-RNA-positive diffuse large-cell lymphoma through the use of R-CHOP, which includes rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, as well as similar treatments [ 100 ]. As such, a SVR after DAA treatment for HCV infection improves the OS and prognosis of NHL patients.…”

Section: Treatment For Acute Exacerbation and Alanine Aminotransferas...mentioning

confidence: 99%

Chronic Hepatitis C: Acute Exacerbation and Alanine Aminotransferase Flare

Matsumoto

Ishii

Arima

et al. 2023

Viruses

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The hepatitis C virus (HCV) causes acute and chronic hepatitis, cirrhosis, and hepatocellular carcinoma, as well as extrahepatic manifestations such as malignant lymphoma. Currently, direct-acting antiviral agents (DAAs) against HCV infection can lead to a sustained virological response (SVR) in almost all HCV-infected patients. In this review article, we discuss acute exacerbation and alanine aminotransferase (ALT) flare in patients with chronic HCV infection. Although acute liver failure caused by HCV infection is rare, careful attention should be paid to the cases with ALT elevation during the natural course of chronic HCV infection. HCV genotype 2 infection, the use of rituximab, and a higher dose of corticosteroid are factors associated with HCV acute exacerbation and ALT flare. Treatment regimens for cancer have been interrupted or changed due to ALT flare due to HCV infection in some patients undergoing chemotherapy for cancer. The pathogenesis of HCV acute exacerbation and ALT flare could involve cellular as well as humoral immune responses. In the DAA era, the earlier introduction of DAAs may prevent chronic HCV-infected patients with acute exacerbation and ALT flare from developing into a more severe form, although DAAs may not be effective for all of them.

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Efficacy and prognosis of antiviral therapy on hepatitis C following treatment of lymphoma in HCV-positive diffuse large-cell lymphoma

Cited by 13 publications

References 18 publications

Direct-Acting Antivirals in Hepatitis C Virus-Associated Diffuse Large B-cell Lymphomas

Direct-Acting Antivirals in Hepatitis C Virus-Associated Diffuse Large B-cell Lymphomas

Considering hepatitis C virus infection as a systemic disease

Chronic Hepatitis C: Acute Exacerbation and Alanine Aminotransferase Flare

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