Assessment of liver stiffness in patients with HCV and mixed cryoglobulinemia undergoing rituximab treatment.
BACKGROUND
Mixed cryoglobulinemia (MC) is a HCV-related lymphoproliferative disorder generally associated with advanced liver disease. Liver stiffness has been significantly correlated with histopathological stage of fibrosis. Moreover, it was influenced by necroinflammatory activity. Rituximab (RTX) is a chimeric anti-CD20 monoclonal antibody inducing transient B lymphocytes depletion that was shown to be useful and safe in the majority of HCV MC patients, leading also to improvement of cirrhotic syndrome. Aim of this study was to evaluate the modifications of liver stiffness following RTX treatment in HCV-related MC patients.


METHODS
Fourteen consecutive patients (10 F, 4 M; mean age 60.43 ± 43) with HCV-related chronic hepatitis (n = 10) or cirrhosis (n = 4) and MC, eligible for RTX treatment, were prospectively enrolled. Intravenous injection of 1 g of RTX was performed at day 0 and at day 15. Assessment of stiffness was carried out by Fibroscan (Echosens, Paris-France) at baseline, 15 days after the first infusion, and at month 1, 3 and 6 after therapy.


RESULTS
MC symptoms significantly improved during the study, especially during the first 3 months. Liver stiffness observed 3 months after treatment was significantly reduced when compared with pre-treatment values (p = 0.01). This difference disappeared after 6 months of follow-up. Cytofluorimetric analysis showed a decrease of CD19+ peripheral blood cells, with the nadir at month 3 after therapy and B cell compartment reconstitution after 6 months.


CONCLUSIONS
This study, for the first time showed that RTX-treatment in HCV-related MC induces a reduction of liver stiffness that is strictly associated with the B-cell depletion.
Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses MASVE, University of Florence, Florence, Italy. cristina.stasi@gmail.com.
Cristina
C
Stasi
Elisa
E
Triboli
Umberto
U
Arena
Teresa
T
Urraro
Antonio
A
Petrarca
Laura
L
Gragnani
Giacomo
G
Laffi
Anna Linda
AL
Zignego
D058846:Antibodies, Monoclonal, Murine-Derived / Q000494:pharmacology / Q000627:therapeutic use*; D018941:Antigens, CD19 / Q000378:metabolism; D003449:Cryoglobulinemia / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D003710:Demography; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000187:drug effects / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D000069283:Rituximab
D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19; D000069283:Rituximab