Potential Treatment of Marginal B-Cell Lymphoma With Antiviral Therapy

Abstract

Background: The association between hepatitis C (HCV) and subtypes of B-cell lymphomas was initially described in epidemiological studies. These subtypes mainly are marginal zone lymphomas (MZLs) and lymphoplasmacytic lymphomas, both of which are indolent lymphomas. Hence there is a reported association - there is a potential role for antiviral strategies to influence the clinical course of these lymphomas. Case: We present a 39-year-old female patient with past medical history of hepatitis C with cirrhosis who underwent orthotropic liver transplantation. She was found to have periportal lymphadenopathy intraoperatively which were sampled. Pathology revealed marginal zone B-cell lymphoma. An MRI obtained one month postoperatively which showed persistent periportal, portocaval and gastrohepatic lymphadenopathy. She was asymptomatic without symptoms of night sweats, fever or weight loss. A subsequent bone marrow biopsy revealed small atypical lymphoid infiltrates suggestive of minimal bone marrow involvement. Given it was a low-grade B-cell lymphoma; patient was followed up and no treatment was initiated. One month later - she was noticed to have jaundice and worsening transaminases. Subsequently, she underwent liver biopsy, which showed changes consistent with severe recurrent hepatitis C. After thorough evaluation, she was started on Sofosbuvir and Ribavirin. The patient completed 24 weeks of therapy and achieved sustained viral response. Subsequently she had a PET scan, which showed no abnormal FDG uptake in the neck, chest, abdomen and pelvis or osseous structures. She remained in remission through her last follow up. Discussion: We report here the response to antiviral treatment of a liver transplant patient with low grade B-cell lymphoma associated with HCV infection. This further supports the potential link between some sub-types of B-cell lymphoma and HCV infection, and supports the use of antiviral treatment in this setting.