title: Rapid clearance of HCV-related splenic marginal zone lymphoma under an interferon-free, NS3/NS4A inhibitor-based treatment. A case report.
abstract: Chronic infection with hepatitis C virus (HCV) may lead to B cell activation and transformation into non-Hodgkin lymphoma (NHL). Molecular mechanisms of B cell transformation by HCV are poorly understood. One of the most common lymphoproliferative disorders in HCV-infected patients is splenic marginal zone lymphoma (SMZL). A case of a 42-years old man, affected by HCV-related SMZL, effectively treated with an IFN-free, NS3-NS4A inhibitor-based regimen, is hereby described. The patient was treated for 16 weeks with faldaprevir, deleobuvir, and ribavirin, achieving a very rapid viral eradication without relevant toxicities. A rapid haematologic response was noted as well, with a statistically significant correlation between viral decay and lymphocyte improvement (coefficient r = 0.55, p = 0.042). The viral clearance led to SMZL cure, even without the use of IFN. Thus, the causative role, played by HCV in SMZL development, is once again reinforced, whereby the antiviral, rather than the anti-proliferative activity of IFN is indirectly proven. A regimen including DAAs should be considered when treating a HCV-related extra-hepatic disease.
authors.affiliation: Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy. Electronic address: roberto.rossotti@ospedaleniguarda.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossotti
authors.affiliation: Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Travi
authors.affiliation: Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Pazzi
authors.affiliation: Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Baiguera
authors.affiliation: Oncology/Hematology Department, Niguarda Cancer Center, "Niguarda Cà Granda" Hospital, Milan, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
authors.affiliation: Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Puoti
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D002352:Carrier Proteins / Q000037:antagonists & inhibitors*; D004279:DNA, Viral / Q000032:analysis*; D016174:Hepacivirus / Q000235:genetics*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D047908:Intracellular Signaling Peptides and Proteins; D008223:Lymphoma / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008297:Male; D013160:Splenic Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D017361:Viral Nonstructural Proteins / Q000037:antagonists & inhibitors*; D012697:Serine Endopeptidases; D043583:Nucleoside-Triphosphatase; D053487:DEAD-box RNA Helicases; D000085242:Viral Proteases
chemical_list: D000998:Antiviral Agents; D002352:Carrier Proteins; D004279:DNA, Viral; D047908:Intracellular Signaling Peptides and Proteins; D017361:Viral Nonstructural Proteins; C084422:NS3 protein, hepatitis C virus; D012697:Serine Endopeptidases; D043583:Nucleoside-Triphosphatase; D053487:DEAD-box RNA Helicases; D000085242:Viral Proteases; C455041:NS4A cofactor peptide, Hepatitis C virus
keywords: DAA; HCV; Splenic marginal zone lymphoma