Diffuse B-large cell lymphomas with hepatitis C virus (HCV) infection: An interim report of a comparative study with or without antiviral treatment after chemotherapy

Background. Antiviral therapy (AVT) with interferon ± ribavirin has shown to be effective in inducing neoplastic regression without chemotherapy (CT) in low-grade non-Hodgkin’s lymphomas (mainly immunocytomas and nodal/extranodal marginal lymphomas) with associated HCV infection (HCV+ve). We have previously shown that high grade, Diffuse B-Large Cell Lymphomas (DBLCL) are HCV+ve in about 12% of cases in Italian population (ASH 2006, abs. 2242). These patients show peculiar clinical characteristics and have an outcome generally not significantly 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 and if significant signs of liver dysfunction are absent. Aims. In the present study we aimed to determine the possible role of AVT, performed after a standard CT treatment, in high grade, HCV+ve DBLCL. Methods. We evaluated the clinical outcome of 28 HCV+ve DBLCL patients who received AVT (a or pegylated interferon ± ribavirin, given at recommended doses and therapy duration for specific HCV genotypes and according to viral response) after first complete or partial remission was achieved by frontline standard CT. Classic or modified CHOP ± rituximab or PROMACE-CytaBOM regimens were generally employed. For comparison, a historical cohort of 24 patients with HCV+ve DBLCL, receiving similar CT, but without AVT, was employed. The two groups were similar for age, sex, clinical stage, liver function, type of prior CT, viral load and HCV genotype. Results. Sequential treatment (CT followed by AVT) was generally well tolerated. Four patients, however, interrupted AVT before three months, due to general malaise or myelotoxicity. HCV clearance was obtained in 54% of patients. An interim evaluation showed a not statistically significant trend (67 vs 54%) in favour of AVT-treated patients in terms of PFS at two years. A weak correlation between viral clearance and longer PFS duration was also observed. Two-year OS, however, was not different between AVT-treated or not treated patients (71 vs 68%, p n.s.). Conclusions. Our currently available data indicate that a sequential treatment with CT followed by AVT is feasible in HCV+ve DBLCL, may induce complete virus clearance and could have a positive impact on remission duration. A larger number of patients and a longer follow-up are required to establish the exact role (if any) of AVT in HCV+ve DLBCL patients.