title: Impact of treatment-related liver toxicity on the outcome of HCV-positive non-Hodgkin's lymphomas.
abstract: We studied 160 Hepatitis C virus (HCV)-positive patients with NHL (59 indolent NHL, 101 aggressive). Median age was 67 years. HCV-RNA was present in 146. HBsAg was positive in seven patients. At diagnosis, ALT value was above UNL in 67 patients. One hundred and twenty patients received an anthracycline-based therapy, alkylators, 28 received chemotherapy plus rituximab. Cytotoxic drugs dose was reduced in 63 patients. Among 93 patients with normal ALT at presentation, 16 patients developed WHO grade II-III liver toxicity. Among 67 patients with abnormal ALT, eight patients had a 3.5 times elevation during treatment. Among 28 patients treated with rituximab and chemotherapy, five patients (18%) developed liver toxicity. Thirty four patients (21%) did not complete treatment (eight for liver toxicity). Median progression-free survival (PFS) for patients who experienced liver toxicity is significantly shorter than median PFS of patients without toxicity (respectively, 2 years and 3.7 years, P = 0.03). After a median F-UP of 2 years, 32 patients died (three for hepatic failure). A significant proportion of patients with HCV+ NHL develop liver toxicity often leading to interruption of treatment. This could be a limit to the application of immunochemotherapy programs. HCV+ lymphomas represent a distinct clinical subset of NHL that deserves specific clinical approach to limit liver toxicity and ameliorate survival.
authors: Divison of Hematology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Viale Golgi 19, Pavia, Italy. luca.arcaini@unipv.it
authors: Luca
authors: L
authors: Arcaini
authors: Michele
authors: M
authors: Merli
authors: Francesco
authors: F
authors: Passamonti
authors: Raffaele
authors: R
authors: Bruno
authors: Ercole
authors: E
authors: Brusamolino
authors: Paolo
authors: P
authors: Sacchi
authors: Sara
authors: S
authors: Rattotti
authors: Ester
authors: E
authors: Orlandi
authors: Elisa
authors: E
authors: Rumi
authors: Virginia
authors: V
authors: Ferretti
authors: Silvia
authors: S
authors: Rizzi
authors: Erika
authors: E
authors: Meli
authors: Cristiana
authors: C
authors: Pascutto
authors: Marco
authors: M
authors: Paulli
authors: Mario
authors: M
authors: Lazzarino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018943:Anthracyclines / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001685:Biological Factors / Q000008:administration & dosage; D056486:Chemical and Drug Induced Liver Injury / Q000821:virology*; D003603:Cytotoxins / Q000008:administration & dosage / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000069283:Rituximab
chemical_list: D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018906:Antineoplastic Agents, Alkylating; D001685:Biological Factors; D003603:Cytotoxins; D000069283:Rituximab