Universal screening for hepatitis C: A needed approach in patients with haematologic malignancies

Angelidakis, Georgios; Dandachi, Dima; Economides, Minas P.; Hosry, Jeff; Granwehr, Bruno; Torres, Harrys A.

doi:10.1111/jvh.12913

Cited by 7 publications

(5 citation statements)

References 10 publications

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“… 4 At present, most cancer centers do not screen patients for HCV routinely. 7 HCV testing in cancer patients is vital to identify chronically infected patients with any cancer. 4 The development of HCC in our patients potentially would have been very low with more effective screening and treatment of HCV infection, extrapolated from a significant reduction in the risk of HCC-P development following HCV eradication.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer

Dandachi

Hassan

Kaseb

et al. 2018

JHC

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IntroductionChronic hepatitis C virus (HCV) infection is one of the leading causes of hepatocellular carcinoma (HCC) worldwide. Antiviral therapy in patients with HCV infection reduces the risk of primary HCC development by 71%–75%. HCV-infected patients with different primary cancers are also at risk for HCC development as a second primary malignancy (HCC-SPM). Limited information is available on the occurrence and characteristics of HCC-SPM. Herein, we determine the prevalence and clinical features of HCV-associated HCC-SPM when compared to primary HCC.Materials and methodsPatients with HCV-associated HCC seen at MD Anderson Cancer Center (2011–2017) were enrolled in a prospective observational study. Patients with multiple cancers diagnosed simultaneously or with hepatitis B virus or HIV coinfections were excluded. At enrollment, patients completed a questionnaire on medical history and HCC risk factors. Information on demographics, comorbidities, HCV treatment, tumor characteristics, treatment modalities, and virologic and oncologic outcomes were extracted from the medical records.ResultsAmong 171 consecutive patients with HCV-associated HCC enrolled, 26 (15%) had HCC-SPM. Most of the underlying primary cancers were solid tumors (85%). In 12 (46%) of these patients, the diagnosis was made incidentally while undergoing surveillance for primary malignancies, and the majority (81%) had their primary cancer in remission. Most patients (72%) with documented HCV viral load had chronic viremia due to lack of diagnosis, lack of treatment, or prior unsuccessful treatment of HCV infection and only 28% had undetectable viral load following successful antiviral therapy. The overall median survival for both groups was 29 months (95% CI: 23–35) without difference between groups (p=0.2).ConclusionCancer patients with any malignancies must be screened for HCV as HCC-SPM can develop in 15% of infected patients. Early HCV diagnosis and treatment should be attempted to prevent the development of HCC-SPM, a condition associated with high mortality in cancer survivors.

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Section: Discussionmentioning

confidence: 99%

Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer

Dandachi

Hassan

Kaseb

et al. 2018

JHC

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“…This finding validates the previous observations from MD Anderson Cancer Center that selective screening practices for HCV would identify a substantial number of infected patients and would still leave many unaware of their infections and support that all patients with cancer should be screened for HCV. 1,35,36 A prospective study at the same center showed that combined birth year-and risk factor-based screening was superior to either screening strategy alone. 37 Despite this, the combined screening strategy had a false-negative rate of 5% (95% confidence interval, 1%-17%).…”

Section: Lack Of Evidence-based Guidelines For Hcv Screening In Patients With Cancermentioning

confidence: 99%

Hepatitis C Virus Infection in Patients With Cancer: Impact on Clinical Trial Enrollment, Selection of Therapy, and Prognosis

2019

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“…Unfortunately, although professional societies recommend universal HCV screening in patients with hematologic malignancies, 24 not all such patients are tested. 25 The chromosomal IGH-BCL2 translocation is present in the vast majority of FLs; it can be detected in up to 90% of cases with highly sensitive methods. 26 However, FL cases lacking IGH-BCL2 translocation do occur, and their pathogenesis is less well studied.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, splenic involvement of NHL should prompt HCV testing. Unfortunately, although professional societies recommend universal HCV screening in patients with hematologic malignancies, 24 not all such patients are tested 25 …”

Section: Discussionmentioning

confidence: 99%

Clinicopathologic characteristics of follicular lymphoma in hepatitis C virus‐infected patients

Hosry

Miranda

Samaniego

et al. 2020

Hematological Oncology

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Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma. It has been hypothesized that chronic hepatitis C virus (HCV) infection stimulates IGH-BCL2 clone proliferation, leading to development of FL. Furthermore, regression of FL after antiviral treatment without chemotherapy has been reported in HCV-infected patients. To clarify the relationship between HCV and FL, we compared the prevalence of IGH-BCL2 translocation and other clinicopathologic characteristics between HCV-infected and HCV-uninfected FL patients and determined the impact of HCV eradication on the oncologic outcomes of HCV-infected FL patients. The study included HCV-infected patients (cases) with FL seen at our institution during 2004-2018. Cases were matched with HCV-uninfected FL patients (controls) according to year of lymphoma diagnosis, sex, and hepatitis B serology. We studied 19 cases and 57 controls. More cases than controls had splenic involvement of FL (26% vs 5%, P = 0.02), higher histologic grade (grade 3 in 56% vs 24%, P = 0.01), absent or weak CD10 expression (42% vs 11%, P = 0.005), and absent BCL2 expression (33% vs 4%, P = 0.004). Compared to controls, cases had a lower rate of detection of IGH-BCL2 translocation (31% vs 68%, P = 0.02). Finally, cases with a sustained virologic response (virologic cure of HCV) had a better 10-year overall survival rate than did cases not treated with antivirals or controls (P = 0.001). In conclusion, HCVinfected patients with FL have unique clinicopathologic characteristics including improved overall survival with HCV eradication. The pathogenesis of FL in HCVinfected patients seems unrelated to antiapoptotic effect of IGH-BCL2 rearrangement.

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Universal screening for hepatitis C: A needed approach in patients with haematologic malignancies

Cited by 7 publications

References 10 publications

Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer

Hepatitis C virus-associated hepatocellular carcinoma as a second primary malignancy: exposing an overlooked presentation of liver cancer

Hepatitis C Virus Infection in Patients With Cancer: Impact on Clinical Trial Enrollment, Selection of Therapy, and Prognosis

Clinicopathologic characteristics of follicular lymphoma in hepatitis C virus‐infected patients

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