title: Antiviral therapy improves overall survival in hepatitis C virus-infected patients who develop diffuse large B-cell lymphoma.
abstract: Chronic Hepatitis C virus (HCV) infection is associated with increased incidence of non-Hodgkin lymphoma. Several studies have demonstrated regression of indolent lymphoma with antiviral therapy (AVT) alone. However, the role of AVT in HCV-infected patients with diffuse large B-cell lymphoma (DLBCL) is unclear. We therefore analyzed AVT's impact on oncologic outcomes of HCV-infected patients (cases) who developed DLBCL. Cases seen at our institution (June 2004-May 2014) were matched with uninfected counterparts (controls) and then divided according to prior AVT consisting of interferon-based regimens. We studied 304 patients (76 cases and 228 controls). More cases than controls had extranodal (79% vs. 72%; p = 0.07) and upper gastrointestinal (GI; 42% vs. 24%; p = 0.004) involvement. Cases never given AVT had DLBCL more refractory to first-line chemotherapy than that in the controls (33% vs. 17%; p = 0.05) and exhibited a trend toward more progressive lymphoma at last examination compared to controls (50% vs. 32%; p = 0.09) or cases given AVT (50% vs. 27%; p = 0.06). Cases never given AVT had worse 5-year overall survival (OS) rates than did the controls (HR, 2.3 [95% CI, 1.01-5.3]; p = 0.04). Furthermore, AVT improved 5-year OS rates among cases in both univariate (median [Interquartile range]: 39 [26-56] vs. 16 [6-41] months, p = 0.02) and multivariate analyses (HR = 0.21 [95% CI, 0.06-0.69]; p = 0.01). This study highlights the negative impact of chronic HCV on survival of DLBCL patients and shows that treatment of HCV infection is associated with a better cancer response to chemotherapy and improves 5-year OS.
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Jeff
authors: J
authors: Hosry
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Parag
authors: P
authors: Mahale
authors: Department of Lymphoma & Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Francesco
authors: F
authors: Turturro
authors: Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Roberto N
authors: RN
authors: Miranda
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Minas P
authors: MP
authors: Economides
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors: Bruno P
authors: BP
authors: Granwehr
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX. htorres@mdanderson.org.
authors: Harrys A
authors: HA
authors: Torres
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000821:virology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D016403:Lymphoma, Large B-Cell, Diffuse / Q000401:mortality / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D007372:Interferons
keywords: antiviral therapy; diffuse large b-cell lymphoma; hepatitis C virus; overall survival