Antiviral treatment with interferon +/- ribavirin after chemotherapy for diffuse large B-cell non-Hodgkin lymphomas with hepatitis C virus (HCV) infection

Background. Antiviral therapy (AVT) with interferon ± ribavirin hasshown to be effective in inducing neoplastic regression withoutchemotherapy (CT) in low-grade non-Hodgkin’s lymphomas (mainlyimmunocytomas and nodal/extranodal marginal lymphomas) with associatedHCV infection (HCV+ve). We have previously shown that highgrade, Diffuse B-Large Cell Lymphomas (DBLCL) are HCV+ve in about12% of cases in Italian population (ASH 2006, abs. 2242). These patientsshow peculiar clinical characteristics and have an outcome generally notsignificantly different, in terms of response rate, progression free survival(PFS) and overall survival (OS), from that of subjects with HCV negative(HCV-ve) DBLCL, when treated with standard or even high dose CT andif significant signs of liver dysfunction are absent. Aims. In the presentstudy we aimed to determine the possible role of AVT, performed aftera standard CT treatment, in high grade, HCV+ve DBLCL. Methods. Weevaluated the clinical outcome of 28 HCV+ve DBLCL patients whoreceived AVT (a or pegylated interferon ± ribavirin, given at recommendeddoses and therapy duration for specific HCV genotypes andaccording to viral response) after first complete or partial remission wasachieved by frontline standard CT. Classic or modified CHOP ± rituximabor PROMACE-CytaBOM regimens were generally employed. Forcomparison, a historical cohort of 24 patients with HCV+ve DBLCL,receiving similar CT, but without AVT, was employed. The two groupswere similar for age, sex, clinical stage, liver function, type of prior CT,viral load and HCV genotype. Results. Sequential treatment (CT followedby AVT) was generally well tolerated. Four patients, however, interruptedAVT before three months, due to general malaise or myelotoxicity.HCV clearance was obtained in 54% of patients. An interim evaluationshowed a not statistically significant trend (67 vs 54%) in favour of AVTtreatedpatients in terms of PFS at two years. A weak correlationbetween viral clearance and longer PFS duration was also observed.Two-year OS, however, was not different between AVT-treated or nottreated patients (71 vs 68%, p n.s.). Conclusions. Our currently availabledata indicate that a sequential treatment with CT followed by AVT isfeasible in HCV+ve DBLCL, may induce complete virus clearance andcould have a positive impact on remission duration. A larger number ofpatients and a longer follow-up are required to establish the exact role(if any) of AVT in HCV+ve DLBCL patients.0724