Can Antiviral Treatment Cure HCV-Associated Lymphoma?

Chronic hepatitis C virus (HCV) infection is prevalent in lymphoproliferative disorders, including B-cell non-Hodgkin lymphoma (NHL), and research suggests that lymphoma development might be related to chronic antigenic stimulation by the long-term presence of HCV. According to a case study recently published in Open Forum Infectious Diseases, the use of direct-acting antivirals (DAAs) to treat the underlying HCV (rather than using interferon-based chemotherapy to treat the lymphoma) can have a curative effect.

The authors reported the case of a 67-year-old male patient with chronic HCV who was followed since 2005, and was diagnosed with hepatocellular carcinoma that was removed in 2014. Before the patient began treatment with DAAs, he also was diagnosed with B-cell NHL.

From May to August 2016, the patient was treated with a combination DAA regimen (sofosbuvir 400 mg/day and ledipasvir 90 mg/day) with “the aim of a possible hemato-oncologic improvement associated with HCV eradication.” At 12-week follow-up, the patient did not report any major complications and there was no indication of HCV upon testing. Another 12 weeks after HCV eradication, FDG-PET imaging showed no uptake in the lymph nodes, suggesting a complete response.

“[These results] indicate that elimination of the causative pathogen could be essential for the treatment of HCV-associated NHL, even without an interferon-based treatment,” the authors wrote. Though the findings are limited because a single patient with irregular follow-up was included, the authors concluded that, “based on the evidence of antiviral efficacy and safety of DAAs compared with interferon-based therapy, we propose that DAAs are so well tolerated, efficacious, and fast-acting that treatment could be considered in any patient with B-cell lymphoma and chronic HCV.”

Source: Hattori N, Ikeda H, Nakano H, et al. Curative effects for B-cell lymphoma accomplished by direct-acting antiviral agents of hepatitis C. Open Forum Infect Dis. 2017 March 25. [Epub ahead of print]