Antiviral Treatment of HCV-Infected Patients with B-Cell Non-Hodgkin Lymphoma: ANRS HC-13 Lympho-C Study.

Hepatitis C virus (HCV) infection is associated with lymphoproliferative disorders and B-cell non-Hodgkin lymphomas (B-NHLs). Evaluation of the efficacy and safety profiles of different antiviral therapies in HCV patients with B-NHL is warranted.First, we evaluated the sustained virologic response (SVR) and safety of Peg-interferon-alpha (Peg-IFN) + ribavirin +/- first protease inhibitors (PI1s) therapy in 61 HCV patients with B-NHL enrolled in a nationwide observational survey compared with 94 matched HCV-infected controls without B-NHL. In a second series, interferon-free regimens using a newly optimal combination therapy with direct-acting antiviral drugs (DAAs) were evaluated in 10 patients with HCV and B-NHL.The main lymphoma type was diffuse large B-cell lymphoma (38%) followed by marginal zone lymphoma (31%). In the multivariate analysis, patients with B-NHL treated by Peg-IFN-based therapy exhibited a greater SVR rate compared with controls, 50.8% vs 30.8%, respectively, p<0.01, odds ratio (OR) = 11.2 [2.3, 52.8]. B-NHL response was better (p = 0.02) in patients with SVR (69%) than in patients without SVR (31%). Premature discontinuation of Peg-IFN-based therapy was significantly more frequent in the B-NHL group (19.6%) compared with the control group (6.3%), p<0.02. Overall, survival was significantly enhanced in the controls than in the B-NHL group (hazard ratio = 34.4 [3.9, 304.2], p< 0.01). Using DAAs, SVR was achieved in 9/10 patients (90%). DAAs were both well tolerated and markedly efficient.The virologic response of HCV-associated B-NHL is high. Our study provides a comprehensive evaluation of different strategies for the antiviral treatment of B-NHL associated with HCV infection

Overall survival of the patients with B-NHL and controls.

<p>Overall survival of the patients with B-NHL and controls.</p

Predictive factors associated with sustained virologic response in the cohort treated by Peg-IFN-based therapy.

<p>Predictive factors associated with sustained virologic response in the cohort treated by Peg-IFN-based therapy.</p

Safety in the cohort treated by Peg-IFN-based therapy.

<p>Safety in the cohort treated by Peg-IFN-based therapy.</p

Characteristics and follow-up of the patients with HCV infection and B-NHL treated by direct-acting antiviral drugs (DAAs).

<p>Marginal zone lymphomas (MZLs); Diffuse large B-cell lymphomas (DLBCLs).</p

Haematological response of the patients from the B-NHL group treated by Peg-IFN-based therapy with or without sustained virologic response, * p = 0.02.

<p>Haematological response of the patients from the B-NHL group treated by Peg-IFN-based therapy with or without sustained virologic response, * p = 0.02.</p

Characteristics of the patients treated by Peg-IFN-based therapy.

<p>Characteristics of the patients treated by Peg-IFN-based therapy.</p

Sustained virologic response of the patients from the cohort treated by Peg-IFN-based therapy, * p< 0.02.

<p>First generation of protease inhibitors (PI1s). A: global sustained virologic response. B: sustained virologic response according to HCV genotype.</p

Flowchart.

<p>Peg-interferon-alpha (Peg-IFN), B-cell non-Hodgkin lymphoma (B-NHL) First generation of protease inhibitors (PI1s), Direct-acting antiviral drugs (DAAs).</p