Presentations, treatment complications and outcomes in HCV‐infected B‐cell lymphoma patients treated with immunochemotherapy: A single institute retrospective study

Abstract

Numerous epidemiologic studies show an association between hepatitis C virus (HCV) and B-cell lymphomas. However, limited studies focused on hepatic consequences after immunochemotherapy, and the prognostic role of HCV is still a matter of debate. We retrospectively analyzed the clinical presentations, hepatic complications, and outcome of B-cell lymphoma patients who were HCV-infected and not HCV-infected. During 2008 to 2013, there were 230 newly diagnosed lymphoma patients who were negative for HBsAg received rituximab-containing chemotherapy as their first-line therapy in our institute. Thirty-six patients (15.7%) were positive for anti-HCV and 194 patients were negative. Most common lymphoma subtypes were DLBCL (73.5%) and follicular lymphoma (19.1%). DLBCL patients had a higher anti-HCV positive rate than FL (18.3% vs 5.6%, P = 0.015). Anti-HCV-positive patients had higher baseline AST and ALT levels (AST, 57.7 ± 46.5 U/L vs 31.1 ± 25.9 U/L, P < 0.001; ALT, 51.6 ± 51.0 U/L vs 25.6 ± 30.6 U/L, P < 0.001), and more liver cirrhosis before treatment (19.4% vs 2.2%, P < 0.001). However, spleen involvement (30.6% vs 21.2%, P = 0.227), extranodal involvements more than one site (27.8% vs 29.4%, P = 0.706), and other parameters are similar in both groups. The most common treatment regimens were R-CHOP like (65.7%) and R-COP (24.8%). After chemotherapy, the patients who were positive for anti-HCV developed more hepatitis (defined as ALT >40 U/L) (80.6% vs 59.8%, P = 0.018) and severe hepatitis (defined as ALT >200 U/L) (30.6% vs 7.7%, P < 0.001). One HCV-positive patient died of hepatic failure after salvage therapy (ESHAP), which was administered at 3 months after last cycle of R-CHOP. The reduction rate of chemotherapy dose (<90% of standard dose) due to hepatotoxicity occurred more often in HCV-infected patients (19.4% vs 2.4%, P = 0.001). Chemotherapy early stop is defined as patients received less cycles of chemotherapy than initial planning or guideline. Chemotherapy early stop rate for all causes was similar in both groups (38.9% vs 26.7%, P = 0.143), but early stop specifically due to hepatotoxicity was slightly higher in patients with HCV infection (3/36 (8.3%) vs 3/165 (1.8%), P = 0.072). The median follow-up time was 21.6 months (range, 1.3-92.8 months) for patients who were HCV-positive and 30.7 months (range, 0.7-78.1 months) for those who were HCV-negative. Complete remission rates were 58.3% and 55.2% in HCV-positive and HCV-negative patients, respectively. Partial response rates were 25.0% and 23.7% in HCV-positive and HCV-negative, respectively. No significant difference was observed in event free survival according to HCV infection (3-year EFS, 41.0% vs 42.8%, P = 0.989). The overall survival tended to be worse in patients who were positive for anti-HCV than those negative for anti-HCV (3-year OS, 47.6% vs 63.2%, P = 0.058). Keywords: B-cell lymphoma; hepatitis C; rituximab