Hepatic Toxicity and Outcome in Hcv-Positive Patients with Diffuse Large B-Cell Lymphoma Treated with Rituximab-Based Chemotherapy

Abstract

ABSTRACT Aim: The influence of rituximab therapy on prognosis and hepatic toxicity (HT) in patients with hepatitis C virus (HCV) positive diffuse large B-cell lymphoma (DLBCL) is unclear. Thus, we aimed to assess HT and clinical outcome in patients with DLBCL and HCV infection who received rituximab containing immunochemotherapy. Methods: We carried out a prospective analysis on a total of 280 HCV-positive patients with DLBCL, 200 of whom received chemotherapy plus rituximab (R-CHT), 80 received chemotherapy (CHT)-only. Survival outcomes and HT were compared according to rituximab administration. Results: The median follow-up was 41 months. Addition of rituximab did not significantly affect prognosis (median progression-free survival, 40 vs 35 months, P =.26; median overall survival, 51 vs 43 months P =.09). Of 200 patients who received rituximab, 53 (26.5%) had severe HT (grade 3-4), compared with 11 of 80 (13.75%) patients who received rituximab-free regimens (P = .033). Among patients treated with rituximab; 50 patients (25%) did not complete planned course of therapy, 14 patients because of hepatic toxicity and 36 patients because of progressive disease. Pretreatment liver function impairment was predictive of severe HT. Conclusions: These results suggest that HCV-positive DLBCL patients do not drive anti-lymphoma benefit from the addition of rituximab due to occurrence of HT that caused significant limitation in the delivery of effective immunotherapy. Specific clinical approach is needed to limit HT and ameliorate survival in this group of patients. Disclosure: All authors have declared no conflicts of interest.