Hepatitis C Virus Infection and Lymphoma

Apart from its well known role as an etiological agent for non-A and non-B viral hepatitis, there is growing evidence that hepatitis C virus is associated to B-cell non-Hodgkin lymphoma. The association between HCV and lymphoproliferative disorders has been recently postulated based on epidemiological data, biological studies and clinical observations. Although various subtypes of lymphomas appear to be associated to HCV, diffuse large B-cell lymphoma, small lymphocytic lymphoma/chronic lymphocytic leukemia and marginal zone lymphoma appeared to be particularly represented among HCV-positive patients. The causative role of HCV in those disorders has been further supported by the response to antiviral therapy. Despite a better understanding of pathophysiological processes at stake leading from HCV infection to overt lymphoma, many issues still need to be further elucidated. Although HCV has been demonstrated to directly infect peripheral blood mononuclear cells both in vitro and, in some cases, in vivo, a strong body of evidence rather supports the hypothesis of an indirect transformation mechanism by which sustained antigenic stimulation leads from oligoclonal to monoclonal expansion and sometimes to lymphoma, probably through secondary oncogenic events. Here, we review epidemiological and biological studies, as well as clinical data on antiviral therapy, linking HCV-infection to B-cell non-Hodgkin lymphoma

Recherche de facteurs de risque immunologiques associés au Lymphome Hodgkinien de l'enfant

Le risque de LH est augmenté en cas de déficit immunitaire acquis ou inné. Les déficits immunitaires innés associés à un risque accru de LH, sont les DICV (Déficit Immunitaire Commun Variable), XLP (Syndrome lymphoprolifératif lié au chromosome X) et ALPS (Syndrome lymphoprolifératif Autoimmun). L objectif de notre travail était d évaluer la prévalence de ces déficits immunitaires chez des enfants atteints de LH. Nous avons reçu, 395 prélèvements de patients atteints de LH au diagnostic. L âge médian de la population étudiée est de 13 ans, allant de 3 à 18 ans. Le sex-ratio M/F est de 1.1. Il augmente à 3 au dessous de l âge de 10 ans. Parmi les biopsies (n=84) qui ont été relues, 87% sont de type scléro-nodulaires (SN), 7% à cellularité mixte (CM) et 6% non spécifié. L EBV est détecté in situ dans 23% des cas de LH. Les patients atteints de LH-EBV+ sont significativement plus jeunes que ceux atteints de LH-EBV- (p=3.10-4). Ce sont plus fréquemment des garçons que des filles (63% ; M/F : 1,7) et fréquemment de sous-type CM (40%). Enfin, ils ont une charge virale EBV significativement plus élevée (p=3.10-3) que les enfants qui ont un LH-EBV-.Parmi les 83 premiers enfants analysés, un immunophénotypage approfondi a montré une diminution de la population lymphocytaire par rapport aux témoins et une lymphopénie B fréquente (31 patients sur 83 soit 37% des patients). La lymphopénie B était corrélée aux facteurs pronostiques connus du LH. Dans un cas parmi les 31, une baisse des immunoglobulines a été mise en évidence ce qui est évocateur de DICV. Nous avons montré que dans les autres cas, les lymphopénies se corrigeaient à distance de la maladie. La recherche de profil cytokinique associé à ces lymphopénies (TGF, BAFF, IL-7) n a pas permis de mettre en évidence de mécanisme physiopathologique simple pour expliquer ces lymphopénies. Nous émettons l hypothèse qu elles sont liées à l exposition au contact des cellules tumorales à des signaux favorisant l apopotose.En ce qui concerne la recherche d autres déficits immunitaires innés, aucun cas évocateur de XLP n a été mis en évidence sur la base de la quantification des lymphocytes NKT. Cinq cas parmi les 83 (6%) avaient une expansion de lymphocytes T DN (Lymphocytes TCRab CD4-CD8-) dans le sang périphérique. Des dosages de Fas ligand et d IL-10 plasmatiques ont permis d exclure un ALPS. Au total, nous n avons pas pu affirmer de défaut qualitatif des sous-populations lymphocytaires évoquant les déficits immunitaires de type XLP et ALPS. Seule une lymphopénie B avec baisse des IgG est évocatrice de DICV. Nous avons étendu l analyse à l ensemble des patients (395patients) avec un contrôle à distance du diagnostic pour ceux qui étaient anormaux. Nous avons identifié 4 patients potentiellement atteints de DICV, 1,5%. Parallèlement, nous avons recherché un déficit de la réponse T anti-EBV par cytomètrie de flux et l Elispot. L étude de la réponse T anti-EBV par la cytométrie de flux, a montré une tendance vers une baisse de la production d IL-2 par les CD4 et les CD8 de patients avec une charge virale EBV élevée en réponse à une stimulation par des peptides EBV en présence de lignées autologues. L étude de la réponse T anti EBV par la technique d ELISPOT sur 9 patients n a pas montré globalement de déficit du contrôle de l EBV sauf pour une jeune patiente de 10 ans ayant une charge virale EBV très élevée sans réponse T anti-EBV efficace. Les résultats que nous avons obtenus restent à approfondir, ce qui permettra d enrichir les connaissances actuelles sur cette pathologie.Hodgkin s Lymphoma (HL) is one of the most frequent lymphomas occurring in childhood. In young children, there is a high predominance in boys and frequent association with Epstein-Barr Virus (EBV). Cohort studies have shown that patients affected by several immune deficiency syndromes - e.g. X-linked lymphoproliferative syndrome (XLP), functional deficit of Fas/FasL pathway and common variable immunodeficiency (CVID) - are risk factors of HL. We intend to search for qualitative and quantitative immune deficiencies as susceptibility factors to child's HL in a prospective study related to Euronet PHL C1 protocol. Eighty-three patients at diagnosis of HL have been analysed. Median age of the study population is 13 years, (5-18 years). Gender-ratio M/F is 1.1 with a larger male predominance before the age of 10 (gender-ratio of 3). The search for a defect of NKT population that would be suggesting of XLP was negative in all patients. A moderate expansion of circulating TCRab+ double negative cells (DNT) has been detected in 5 patients. This expansion has been further explored in the hypothesis of a defect of Fas/FasL pathway by plasmatic quantification of Fas ligand and Il-10. This led to the exclusionof the diagnosis of ALPS. An unexpected high frequency of B-cell lymphopenia has been detected in 31 out of 83 patients (37%). Peripheral B cell lymphopenia was associated with the following poor prognostic factors: advanced stages (p1,000 EBV copies per 250000 PBMCs). These cases will be further explored by molecular analyses.Our findings confirm the known epidemiological data of HL now mainly associated to NS subtype in children and adolescents and EBV status in HL at this age. We show that peripheral B cell lymphopenia in paediatric and adolescent HL patients is frequent and associated with poor prognosis factors. We confirm the association between CVID and HL.PARIS11-SCD-Bib. électronique (914719901) / SudocSudocFranceF

Cancer-Specific Mortality, Cure Fraction, and Noncancer Causes of Death Among Diffuse Large B-cell Lymphoma Patients in the Immunochemotherapy Era.

BACKGROUND Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown. METHODS Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs). RESULTS Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years. CONCLUSIONS Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017. © 2017 American Cancer Society

Loss of p27/Kip1 promotes metaplasia in the pancreas via the regulation of Sox9 expression.

p27Kip1 (p27) is a negative regulator of proliferation and a tumor suppressor via the inhibition of cyclin-CDK activity in the nucleus. p27 is also involved in the regulation of other cellular processes, including transcription by acting as a transcriptional co-repressor. Loss of p27 expression is frequently observed in pancreatic adenocarcinomas in human and is associated with decreased patient survival. Similarly, in a mouse model of K-Ras-driven pancreatic cancer, loss of p27 accelerates tumor development and shortens survival, suggesting an important role for p27 in pancreatic tumorigenesis. Here, we sought to determine how p27 might contribute to early events leading to tumor development in the pancreas. We found that K-Ras activation in the pancreas causes p27 mislocalization at pre-neoplastic stages. Moreover, loss of p27 or expression of a mutant p27 that does not bind cyclin-CDKs causes the mislocalization of several acinar polarity markers associated with metaplasia and induces the nuclear expression of Sox9 and Pdx1 two transcription factors involved in acinar-to-ductal metaplasia. Finally, we found that p27 directly represses transcription of Sox9, but not that of Pdx1. Thus, our results suggest that K-Ras activation, the earliest known event in pancreatic carcinogenesis, may cause loss of nuclear p27 expression which results in derepression of Sox9, triggering reprogramming of acinar cells and metaplasia

Outcome of COVID-19 in Patients With Mantle Cell Lymphoma-Report From the European MCL Registry

Data on outcome of patients with mantle cell lymphoma (MCL) and COVID-19 infection are limited. The European MCL (EMCL) registry is a centralized registry of the EMCL network, collecting real-world information about treatments and disease courses. During the COVID-19 pandemic, additional data on MCL patients with COVID-19 infection were collected, aiming to identify risk factors for mortality from COVID-19. In our retrospective, multicenter, international study, we collected data from 63 MCL patients with a median age of 64 years (range, 44–84) in 9 countries with evidence of a COVID-19 infection between February 2020 and October 2021. The overall mortality rate was high (44.4%), especially in hospitalized patients (61%) and in patients with need for intensive care unit care (94%). Patients receiving rituximab had significantly poorer survival than patients not receiving rituximab (P = 0.04). Our data highlight the importance of prevention strategies and underline the need for effective vaccination in this vulnerable cohort

Age, successive waves, immunization, and mortality in elderly COVID-19 hematological patients: EPICOVIDEHA findings

Elderly patients with hematologic malignancies face the highest risk of severe COVID-19 outcomes. The infection's impact on different age groups remains unstudied in detail.We analyzed elderly patients (age groups: 65-70, 71-75, 76-80, and >80 years old) with hematologic malignancies included in the EPICOVIDEHA registry between January 2020 and July 2022. Univariable and multivariable Cox regression models were conducted to identify factors influencing death in COVID-19 patients with hematological malignancy.The study included data from 3,603 elderly patients (aged 65 or older) with hematological malignancy, with a majority being male (58.1%) and a significant proportion having comorbidities. The patients were divided into four age groups, and the analysis assessed COVID-19 outcomes, vaccination status, and other variables in relation to age and pandemic waves. The 90-day survival rate for patients with COVID-19 was 71.2%, with significant differences between groups. The pandemic waves had varying impacts, with the first wave affecting patients over 80 years old, the second being more severe in 65-70, and the third being the least severe in all age groups. Factors contributing to 90-day mortality included age, comorbidities, lymphopenia, active malignancy, acute leukemia, less than three vaccine doses, severe COVID-19, and using only corticosteroids as treatment.These data underscore the heterogeneity of elderly hematological patients, highlight the different impacts of COVID-19 waves and the pivotal importance of vaccination, and may help in planning future healthcare efforts

Mediating effect of soluble B-cell activation immune markers on the association between anthropometric and lifestyle factors and lymphoma development

Sustained B-cell activation is an important mechanism contributing to B-cell lymphoma (BCL). We aimed to validate four previously reported B-cell activation markers predictive of BCL risk (sCD23, sCD27, sCD30, and CXCL13) and to examine their possible mediating effects on the association between anthropometric and lifestyle factors and major BCL subtypes. Pre-diagnostic serum levels were measured for 517 BCL cases and 525 controls in a nested case-control study. The odds ratios of BCL were 6.2 in the highest versus lowest quartile for sCD23, 2.6 for sCD30, 4.2 for sCD27, and 2.6 for CXCL13. Higher levels of all markers were associated with increased risk of chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), and diffuse large B-cell lymphoma (DLBCL). Following mutual adjustment for the other immune markers, sCD23 remained associated with all subtypes and CXCL13 with FL and DLBCL. The associations of sCD23 with CLL and DLBCL and CXCL13 with DLBCL persisted among cases sampled > 9 years before diagnosis. sCD23 showed a good predictive ability (area under the curve = 0.80) for CLL, in particular among older, male participants. sCD23 and CXCL13 showed a mediating effect between body mass index (positive) and DLBCL risk, while CXCL13 contributed to the association between physical activity (inverse) and DLBCL. Our data suggest a role of B-cell activation in BCL development and a mediating role of the immune system for lifestyle factors

Association of Killer Cell Immunoglobulin-Like Receptor Genes with Hodgkin's Lymphoma in a Familial Study

BACKGROUND: Epstein-Barr virus (EBV) is the major environmental factor associated with Hodgkin's lymphoma (HL), a common lymphoma in young adults. Natural killer (NK) cells are key actors of the innate immune response against viruses. The regulation of NK cell function involves activating and inhibitory Killer cell Immunoglobulin-like receptors (KIRs), which are expressed in variable numbers on NK cells. Various viral and virus-related malignant disorders have been associated with the presence/absence of certain KIR genes in case/control studies. We investigated the role of the KIR cluster in HL in a family-based association study. METHODOLOGY: We included 90 families with 90 HL index cases (age 16–35 years) and 255 first-degree relatives (parents and siblings). We developed a procedure for reconstructing full genotypic information (number of gene copies) at each KIR locus from the standard KIR gene content. Out of the 90 collected families, 84 were informative and suitable for further analysis. An association study was then carried out with specific family-based analysis methods on these 84 families. PRINCIPAL FINDINGS: Five KIR genes in strong linkage disequilibrium were found significantly associated with HL. Refined haplotype analysis showed that the association was supported by a dominant protective effect of KIR3DS1 and/or KIR2DS1, both of which are activating receptors. The odds ratios for developing HL in subjects with at least one copy of KIR3DS1 or KIR2DS1 with respect to subjects with neither of these genes were 0.44[95% confidence interval 0.23–0.85] and 0.42[0.21–0.85], respectively. No significant association was found in a tentative replication case/control study of 68 HL cases (age 18–71 years). In the familial study, the protective effect of KIR3DS1/KIR2DS1 tended to be stronger in HL patients with detectable EBV in blood or tumour cells. CONCLUSIONS: This work defines a template for family-based association studies based on full genotypic information for the KIR cluster, and provides the first evidence that activating KIRs can have a protective role in HL

Nirmatrelvir/ritonavir in COVID-19 patients with haematological malignancies:a report from the EPICOVIDEHA registry

Background: Nirmatrelvir/ritonavir treatment decreases the hospitalisation rate in immunocompetent patients with COVID-19, but data on efficacy in patients with haematological malignancy are scarce. Here, we describe the outcome of nirmatrelvir/ritonavir treatment in a large cohort of the latter patients. Methods: This is a retrospective cohort study from the multicentre EPICOVIDEHA registry (NCT04733729) on patients with haematological malignancy, who were diagnosed with COVID-19 between January and September 2022. Patients receiving nirmatrelvir/ritonavir were compared to those who did not. A logistic regression was run to determine factors associated with nirmatrelvir/ritonavir administration in our sample. Mortality between treatment groups was assessed with Kaplan–Meier survival plots after matching all the patients with a propensity score. Additionally, a Cox regression was modelled to detect factors associated with mortality in patients receiving nirmatrelvir/ritonavir. Findings: A total of 1859 patients were analysed, 117 (6%) were treated with nirmatrelvir/ritonavir, 1742 (94%) were treated otherwise. Of 117 patients receiving nirmatrelvir/ritonavir, 80% had received ≥1 anti-SARS-CoV-2 vaccine dose before COVID-19 onset, 13% of which received a 2nd vaccine booster. 5% were admitted to ICU. Nirmatrelvir/ritonavir treatment was associated with the presence of extrapulmonary symptoms at COVID-19 onset, for example anosmia, fever, rhinitis, or sinusitis (aOR 2.509, 95%CI 1.448–4.347) and 2nd vaccine booster (aOR 3.624, 95%CI 1.619–8.109). Chronic pulmonary disease (aOR 0.261, 95%CI 0.093–0.732) and obesity (aOR 0.105, 95%CI 0.014–0.776) were not associated with nirmatrelvir/ritonavir use. After propensity score matching, day-30 mortality rate in patients treated with nirmatrelvir/ritonavir was 2%, significantly lower than in patients with SARS-CoV-2 directed treatment other than nirmatrelvir/ritonavir (11%, p = 0.036). No factor was observed explaining the mortality difference in patients after nirmatrelvir/ritonavir administration. Interpretation: Haematological malignancy patients were more likely to receive nirmatrelvir/ritonavir when reporting extrapulmonary symptoms or 2nd vaccine booster at COVID-19 onset, as opposed to chronic pulmonary disease and obesity. The mortality rate in patients treated with nirmatrelvir/ritonavir was lower than in patients with targeted drugs other than nirmatrelvir/ritonavir. Funding: EPICOVIDEHA has received funds from Optics COMMIT (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223).</p

Herpes-Virus Infection in Patients with Langerhans Cell Histiocytosis: A Case-Controlled Sero-Epidemiological Study, and In Situ Analysis

BACKGROUND: Langerhans cell histiocytosis (LCH) is a rare disease that affects mainly young children, and which features granulomas containing Langerhans-type dendritic cells. The role of several human herpesviruses (HHV) in the pathogenesis of LCH was suggested by numerous reports but remains debated. Epstein-barr virus (EBV, HHV-4), & Cytomegalovirus (CMV, HHV-5) can infect Langerhans cells, and EBV, CMV and HHV-6 have been proposed to be associated with LCH based on the detection of these viruses in clinical samples. METHODOLOGY: We have investigated the prevalence of EBV, CMV and HHV-6 infection, the characters of antibody response and the plasma viral load in a cohort of 83 patients and 236 age-matched controls, and the presence and cellular localization of the viruses in LCH tissue samples from 19 patients. PRINCIPAL FINDINGS: The results show that prevalence, serological titers, and viral load for EBV, CMV and HHV-6 did not differ between patients and controls. EBV was found by PCR in tumoral sample from 3/19 patients, however, EBV small RNAs EBERs -when positive-, were detected by in situ double staining in bystander B CD20+ CD79a+ lymphocytes and not in CD1a+ LC. HHV-6 genome was detected in the biopsies of 5/19 patients with low copy number and viral Ag could not be detected in biopsies. CMV was not detected by PCR in this series. CONCLUSIONS/SIGNIFICANCE: Therefore, our findings do not support the hypothesis of a role of EBV, CMV, or HHV-6 in the pathogenesis of LCH, and indicate that the frequent detection of Epstein-barr virus (EBV) in Langerhans cell histiocytosis is accounted for by the infection of bystander B lymphocytes in LCH granuloma. The latter observation can be attributed to the immunosuppressive micro environment found in LCH granuloma