The clinical impact of hepatitis C virus infection in Egyptian multiple myeloma patients

Abstract

Background Multiple myeloma (MM) is a human B cell neoplasia characterized by the clonal proliferation of malignant plasma cells in the bone marrow. Worldwide, hepatitis C virus (HCV) infection is a public health problem. For MM patients, the clinical impact of preexisting HCV infection is still unclear. We aim to assess the clinical characteristics and the prevalence of the HCV infection in Egyptian MM patients. This observational study included 81 MM patients. HCV antibody assay was performed, and positive cases were confirmed using a reverse transcription-quantitative PCR (RT-PCR) method. Results Fifteen (18.5%) patients were anti-HCV antibody positive. Only 6/15 (7.4%) patients were HCV RNA positive by RT-PCR. Liver affection in the form of hyperbilirubinemia with grade 4 adverse events was significantly higher in the anti-HCV positive/HCV RNA positive group versus anti HCV negative group (16.7% vs. 1.5%, p value = 0.005). The median HCV-RNA before the initiation of chemotherapy was 2.5 log IU/ml with mean ± SD = 4.25 ± 1.6 with no HCV reactivation. In the univariate and multivariate analysis, HCV infection was not an independent factor related to DFS. Low hemoglobin level < 10 g/dL (HR 0.59, 95% CI, 0.36–0.97, p value = 0.037) and abnormal serum total bilirubin level (HR 1.9, 95% CI 1.03–3.5, p value = 0.039) influenced DFS in the univariate analysis. However, in the multivariate analysis, serum calcium level greater than 12 mg/dL (HR 7.04, 95% CI 1.12–44.45, p value = 0.038) and abnormal serum total bilirubin level (HR 10.9, 95% CI 2.92–41.02, p value = < 0.001) remained statistically significant worse prognostic factors. Conclusion In conclusion, our study revealed the prevalence of HCV infection in Egyptian MM patients. Serologic tests at diagnosis are necessary to identify these patients, and confirmation of positive cases by molecular techniques should be mandatory, with regular follow-up for liver dysfunction. Finally, further larger studies explaining the molecular mechanisms linking HCV and the MM pathogenesis are warranted.

Epidemiology, Treatment Trends, and Outcomes of Multiple Myeloma in the Middle East and Africa: A Systematic Review

“…Abnormal bilirubin levels and higher serum calcium levels were associated with higher HR of 7.04 and 10.9, respectively (with p-values of \<0.001 and 0.038, respectively) for disease-free survival in MM. 13 Similar findings were reported in the study by Nasr et al . (2021), in which the presence of hypercalcemia during diagnosis was associated with shorter progression-free survival (PFS) (unadjusted HR = 6.48; p\<0.008) and OS (unadjusted HR = 6.58; p\<0.006).…”

“… 1,14,18,19,23 Of the 10 studies in which patients were classified according to the International Staging System (ISS), five reported stage 3 (40.6%–53% of all MM cases) 1,12,18,21,24 whereas six reported that MM was most commonly diagnosed at stage 2 (41%–67%). 13,16,19,22,23 The male:female ratios ranged from 0.61 to 2.0 across all 14 reports. 14,24 Eleven studies enrolled newly diagnosed patients with MM.…”

“…They were further maintained with lenalidomide. 13 A study conducted in Morocco concluded that in developing countries, ASCT with no cryopreservation reduces the costs of hospitalization and essential equipment. 15…”

Efficacy of Antiviral Treatment in Hepatitis C Virus (HCV)-Driven Monoclonal Gammopathies Including Myeloma

“…This new approach should be useful for a significant fraction of MGUS and MM patients: for instance, a recent study revealed that until 7.4% of MM patients were positive for HCV RNA by RT-PCR assay. In this study, the authors emphasize that serologic tests at the time of diagnosis of MM are necessary to identify infected patients, and they propose that confirmation of positive cases by molecular techniques should be mandatory ( 29 ). Whether the gammapathy is linked to the infectious agent can then be addressed by showing that the patient’s monoclonal Ig reacts against the pathogen.…”

“…This work was supported by grants to SH from the Ligue Nationale contre le Cancer (Comiteś Deṕartementaux 44, 56, 29,85,35) and International Myeloma Foundation (IMF) (Brian D. Novis senior grant). We acknowledge the Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBERONC, AECC (Accelerator Award and Ideas Semilla), and the CRIS foundation for their help.…”