Direct-acting antivirals in the treatment of HCV-associated malignant lymphomas

Czech version

Authors: J. Šperl ¹; S. Fraňková ¹; E. Sticová ²; L. Bartoňová ²; M. Drastichová ³; P. Štirand ¹
Authors‘ workplace: Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha ¹; Pracoviště klinické a transplantační patologie, Transplantcentrum, IKEM, Praha ²; Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha ³
Published in: Gastroent Hepatol 2017; 71(2): 138-144
Category: Hepatology: Original Article
doi: https://doi.org/10.14735/amgh2017138

Overview

HCV-associated lymphoproliferative disorders, presenting most commonly by mixed cryoglobulinaemia type 2 with vasculitis or B-cell non-Hodgkin lymphomas, constitute the severest form of extrahepatic complications of HCV. The pathogenetic mechanism of this condition resides in long-term stimulation of B lymphocytes by the E2 protein of the virus, leading to activation and proliferation with subsequent clonal expansion of B lymphocytes. Antiviral treatment, which leads to virus eradication, is the treatment of choice in indolent lymphomas. In aggressive lymphomas, immuno- and chemotherapy are followed by antiviral therapy in order to prevent lymphoma relapse and HCV infection reactivation. Interferon-α-based therapies used in the past had had only poor efficacy in patients with advanced liver disease and genotype 1. We describe three patients with HCV-associated lymphoma, two women and one man, aged 57, 65, and 55 years, resp., who had HCV genotype 1b infection and advanced liver disease (F3 and F4) at the time of lymphoma manifestation. They had been unsuccessfully treated with peginterferon-α and ribavirin and diagnosed based on the results of liver ultrasound imaging focused on early hepatocellular carcinoma detection. Two patients had a newly described mass in the liver and the third patient had enlarged lymph nodes in the liver hilum. Lymphoma remission was achieved in all three patients using a combination of hemato-oncological and antiviral treatments based on direct-acting antivirals. The first patient achieved sustained virological response with the combination of peginterferon-α, ribavirin and boceprevir, the other two patients with the combination of direct-acting antivirals, ritonavir-boosted paritaprevir, ombitasvir and dasabuvir. All the patients achieved also remission of the lymphoma, lasting so far 24, 26 and 45 months after treatment cessation. This study focuses on the treatment of patients with HCV-associated malignant lymphoma with direct-acting antivirals and on the need for hepatocellular carcinoma surveillance, which can detect not only early-stages of hepatocellular carcinoma, but also lymphomas that should be verified histologically before being treated.

Key words:
chronic hepatitis C – HCV-associated lymphoma – direct-acting-antivirals

The authors declare the have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
3. 3. 2017

Accepted:
17. 3. 2017

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