Impact of treatment-related liver toxicity on the outcome of HCV-positive non-Hodgkin's lymphomas.
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.
Arcaini
Luca
L
Divison of Hematology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Viale Golgi 19, Pavia, Italy. luca.arcaini@unipv.it
Merli
Michele
M
Passamonti
Francesco
F
Bruno
Raffaele
R
Brusamolino
Ercole
E
Sacchi
Paolo
P
Rattotti
Sara
S
Orlandi
Ester
E
Rumi
Elisa
E
Ferretti
Virginia
V
Rizzi
Silvia
S
Meli
Erika
E
Pascutto
Cristiana
C
Paulli
Marco
M
Lazzarino
Mario
M
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
D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018906:Antineoplastic Agents, Alkylating; D001685:Biological Factors; D003603:Cytotoxins; D000069283:Rituximab