Efficacy and safety of new direct antiviral agents in HCV infected patients with Diffuse Large B Cell Non-Hodgkin Lymphoma

Abstract

Introduction: The association of HCV with Non-Hodgkin Lymphoma (NHL) has been demonstrated all over the world. The new interferon-free, direct antiviral agents (DAA), showed high efficacy and safety, and preliminary data seem to confirm their activity on low-grade NHL. The question arises as whether or not -and how- to treat the HCV positive patients suffering from diffuse large B cell lymphomas(DLBCL). Aim of this observational study was to evaluate whether the DAAs antiviral treatment of DLBCL/HCV-infected patients in concomitance with chemotherapy is a safe and effective option. Methods:20 (13 males and 7 females), HCV1b positive subjects, undergoing chemotherapy for DLBCL, were enrolled between June 2015 and December 2015. After informed consent, all the patients underwent to antiviral therapy with sofosbuvir/ledipasvir and chemotherapy (14 R-CHOP and 6 CHOP) for DLBCL. Complete hematological (REAL,Ann-Harbor and IPI scores) and hepatological (viral markers, liver stiffness and biochemical parameters) evaluations were made. A historical retrospective cohort of 101 DLBCL/HCV positive patients not undergone to antiviral treatment was enrolled for comparison. Results: DAA-treated and untreated patients were similar for sex distribution, IPI score and NHL stage, and differed for age (older in treated), chemotherapy and use of antiviral therapy. Overall-survival (OS) and disease-free-survival (DFS) were evaluated among a 52 weeks of follow-up. No statistical difference was found in OS after 52 weeks (p:0.122), whereas a statistically significant higher DFS was achieved in treated patients(p:0.036). At the multivariate analysis, only IPI score and DAA were independently correlated with a better DFS. No differences in adverse events were reported. Conclusions: DAA-treatment in concomitance with chemotherapy showed to be safe and effective in influencing the remission of aggressive lymphomas in HCV patients. This article is protected by copyright. All rights reserved.

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