Remission of Follicular Lymphoma after Treatment for Hepatitis C Virus Infection

Maciocia, Nicola; O’Brien, Alastair; Ardeshna, Kirit M.

doi:10.1056/nejmc1513288

Cited by 33 publications

(30 citation statements)

References 4 publications

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“…The best evidence of a direct relationship between HCV and B‐cell NHL is the demonstration of regression of B‐cell NHL resulting from anti‐HCV therapy with interferon, which has antiproliferative properties . Early reports of the use of interferon‐free regimens also suggested benefit …”

Section: Mechanisms By Which Hcv Contributes To the Development Of Camentioning

confidence: 99%

The oncologic burden of hepatitis C virus infection: A clinical perspective

Torres

Shigle

Hammoudi

et al. 2017

CA A Cancer J Clinicians

110

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Chronic hepatitis C virus (HCV) infection affects millions of people worldwide and is associated with cancer. Direct-acting antivirals (DAAs) have changed HCV treatment paradigms, but little is known about management of HCV infection in patients with cancer. The substantial burden of HCV infection in patients with cancer and the inconclusive evidence regarding detection and management of HCV infection in patients with cancer prompted us to review the literature and formulate recommendations. Patients for whom HCV screening is recommended included all patients with hematological malignancies, hematopoietic cell transplant candidates or patients with hepatocellular carcinoma (HCC). There is lack of consensus-based recommendations for the identification of other cancer patients but physicians may consider screening patients belonging to groups at heightened risk of HCV infection including persons born during 1945–1965 and those at high risk for infection. Patients with evidence of HCV infection should be assessed by an expert to evaluate liver disease severity, comorbidities associated with HCV infection, and treatment opportunities. DAA therapy should be tailored on the basis of patient prognosis, type of cancer, cancer treatment plan, and hepatic and virologic parameters. HCV-infected cancer patients with cirrhosis (or even advanced fibrosis) and those at risk for liver disease progression, especially patients with HCV-associated comorbidities, should have ongoing follow-up, regardless of whether there is a sustained virologic response, to ensure timely detection and treatment of HCC. HCV infection and its treatment should not be considered contraindications to cancer treatment and should not delay the initiation of an urgent cancer therapy.

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Section: Mechanisms By Which Hcv Contributes To the Development Of Camentioning

confidence: 99%

The oncologic burden of hepatitis C virus infection: A clinical perspective

Torres

Shigle

Hammoudi

et al. 2017

CA A Cancer J Clinicians

110

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“…Interestingly, reactivation of other co-infected viruses, such as herpes virus, was observed after DAA-based anti-HCV therapy [49], suggesting simultaneous loss of bystander immune response to the viruses and possibly to neoplastic cells, which may lead to higher HCC recurrence after DAA treatment. On the other hand, complete remission of follicular lymphoma after DAA-based therapy was reported, suggesting that the influence of DAA-based SVR on cancer may vary according to cancer types and biological/clinical contexts [50]. …”

Section: Introductionmentioning

confidence: 99%

Hepatitis C-related hepatocellular carcinoma in the era of new generation antivirals

Baumert

Jühling

Ono

et al. 2017

BMC Med

123

122

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Hepatitis C virus infection is a major cause of hepatocellular carcinoma worldwide. Interferon has been the major antiviral treatment, yielding viral clearance in approximately half of patients. New direct-acting antivirals substantially improved the cure rate to above 90%. However, access to therapies remains limited due to the high costs and under-diagnosis of infection in specific subpopulations, e.g., baby boomers, inmates, and injection drug users, and therefore, hepatocellular carcinoma incidence is predicted to increase in the next decades even in high-resource countries. Moreover, cancer risk persists even after 10 years of viral cure, and thus a clinical strategy for its monitoring is urgently needed. Several risk-predictive host factors, e.g., advanced liver fibrosis, older age, accompanying metabolic diseases such as diabetes, persisting hepatic inflammation, and elevated alpha-fetoprotein, as well as viral factors, e.g., core protein variants and genotype 3, have been reported. Indeed, a molecular signature in the liver has been associated with cancer risk even after viral cure. Direct-acting antivirals may affect cancer development and recurrence, which needs to be determined in further investigation.

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“…Studies have shown that DAA therapy alone (without chemotherapy) could induce both rapid clearance of HCV viraemia and complete remission of HCV-related splenic or disseminated MZL, 28,29 and follicular lymphoma. 30 ≥24 weeks, the patients had a similar prognosis as their counterparts without HCV. This suggests that in addition to HCV clearance, interferon therapy might have a cytostatic effect on lymphoma.…”

Section: Discussionmentioning

confidence: 76%

“…The recently available direct antiviral agents (DAA) can eradicate HCV rapidly and directly without immunomodulatory effects. Studies have shown that DAA therapy alone (without chemotherapy) could induce both rapid clearance of HCV viraemia and complete remission of HCV‐related splenic or disseminated MZL, and follicular lymphoma . A recent case series demonstrated that DAA therapy induced SVR of 98%, as well as a high haematological response rate (67%) without chemotherapy in 46 patients with indolent B‐cell NHL, especially MZL .…”

Section: Discussionmentioning

confidence: 99%

Early antiviral therapy reduces the risk of lymphoma in patients with chronic hepatitis C infection

Liu

Tseng

et al. 2018

Aliment Pharmacol Ther

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Summary Background Chronic hepatitis C infection is linked to lymphoma development. Aim To investigate whether antiviral therapy prevents the risk of HCV‐related lymphoma. Methods Patients diagnosed with chronic hepatitis C were retrieved from the Taiwan National Health Insurance Research Database during 2004‐2012. We included patients who received pegylated interferon and ribavirin (PegIFN/RBV) antiviral therapy for ≥24 weeks (PegIFN/RBV cohort) or hepatoprotectants for ≥90 days without antiviral therapy (HCV‐untreated cohort). Both cohorts were matched by age, sex, and comorbidities through propensity scores and followed for newly diagnosed lymphoma or non‐Hodgkin's lymphoma (NHL). Results In total, 24 133 patients were included in both the PegIFN/RBV and HCV‐untreated cohort. The lymphoma incidence was significantly higher in the untreated than in the treated cohort (66.48 vs 43.34 per 100 000 person‐years, P = 0.029). After adjusting for confounders, the patients who received PegIFN/RBV therapy were at a lower risk of developing lymphoma compared with the untreated patients (hazard ratio [HR]: 0.64, 95% confidence interval [CI]: 0.43‐0.96, P = 0.030). Moreover, this beneficial effect was mainly observed in patients with chronic hepatitis C <60 years old with a relative risk reduction of 51% for all lymphoma (HR: 0.49, 95% CI: 0.29‐0.82, P = 0.007) and 48% for non‐Hodgkin's lymphoma (HR: 0.52, 95% CI: 0.30‐0.91, P = 0.022). The risk of all lymphoma or non‐Hodgkin's lymphoma development after antiviral therapy was lowered to that of subjects without HCV. Conclusions PegIFN/RBV‐based antiviral therapy significantly reduced the risk of lymphoma, especially non‐Hodgkin's lymphoma; the reduction was mostly among patients <60 years old. Early antiviral therapy for chronic hepatitis C is suggested.

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Remission of Follicular Lymphoma after Treatment for Hepatitis C Virus Infection

Cited by 33 publications

References 4 publications

The oncologic burden of hepatitis C virus infection: A clinical perspective

The oncologic burden of hepatitis C virus infection: A clinical perspective

Hepatitis C-related hepatocellular carcinoma in the era of new generation antivirals

Early antiviral therapy reduces the risk of lymphoma in patients with chronic hepatitis C infection

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