Advances in Pharmacoepidemiology and Drug Safety

Abstract

Antiviral Treatment in Patients with HCV-Associated Lymphoproliferative Disorders

Pawlowska M, Pilarczyk M and Halota W

Clinical course of HCV infection may be connected with extra-hepatic manifestations associated with lymphoproliferative disorders as mixed cryoglobulinemia (MC) and non-Hodkin B cell lymphoma (B-NHL). The incidence of HCV infection in MC patients exceeds 80%, and among patients with B cell non-Hodgkin's lymphoma 10-17%, whereas this frequency is correlated with the prevalence of HCV in different geographic regions.

2015 European Association for the Study of the Liver (EASL) recommendations on Treatment of Hepatitis C prioritizes therapy of patients with extra-hepatic manifestations of HCV infection regardless of liver fibrosis. Antiviral treatment resulted in HCV RNA serum disappearance and tumor regression in the majority of patients with indolent B-NHL. It was revealed the high percentage of 5-year overall survival (OS), and 5-year progression-free survival (PFS) for the treated patients. Antiviral therapy improved the prognosis of lymphoproliferative disease, independent of its histological form.

Due to the higher than in the general population, incidence of HCV infections in patients with haematological malignancies, it is desirable to test towards the infection all patients with B-NHL. Antiviral therapy should be considered as a therapeutic option for patients with indolent B-NHL who do not require intensive cytoreduction, because effective anti-HCV treatment induces lasting B-NHL clinical remission. It is also recommended to test towards the HCV infection and carry out an examination evaluating the anti HCV treatment in patients with acute and chronic lymphocytic leukemia (ALL and CLL).