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World J Gastrointest Oncol. Mar 15, 2012; 4(3): 46-53
Published online Mar 15, 2012. doi: 10.4251/wjgo.v4.i3.46
HCV infection, B-cell non-Hodgkin’s lymphoma and immunochemotherapy: Evidence and open questions
Maria Christina Cox, Maria Antonietta Aloe-Spiriti, Elena Cavalieri, Eleonora Alma, Elia Gigante, Paola Begini, Caterina Rebecchini, Gianfranco Delle Fave, Massimo Marignani
Maria Christina Cox, Maria Antonietta Aloe-Spiriti, Elena Cavalieri, Eleonora Alma, Caterina Rebecchini, Department of Haematology, Sant’Andrea Hospital, La Sapienza University, 00139 Rome, Italy
Elia Gigante, Paola Begini, Gianfranco Delle Fave, Massimo Marignani, Department of Gastroenterology and Liver Disease, Sant’Andrea Hospital, La Sapienza University, 00139 Rome, Italy
Author contributions: All authors contrubited to this manuscript.
Correspondence to: Maria Christina Cox, MD, Department of Haematology, Sant’Andrea Hospital, La Sapienza University, via di Grotta Rossa 1034, 00139 Rome, Italy. chrisscox@gmail.com
Telephone: +39-6-3377-5052 Fax: +39-6-3377-6675
Received: May 18, 2011
Revised: November 2, 2011
Accepted: November 10, 2011
Published online: March 15, 2012
Abstract

There is plenty of data confirming that hepatitis C virus (HCV) infection is a predisposing factor for a B-cell non-Hodgkin’s lymphoma (B-NHL) outbreak, while relatively few reports have addressed the role of HCV in affecting B-NHL patients’ outcome. HCV infection may influence the short-term outcome of B-NHL because of the emergence of severe hepatic toxicity (HT) during immunochemotherapy. Furthermore, the long term outcome of HCV-related liver disease and patients’ quality of life will possibly be affected by Rituximab maintenance, multiple-lines of toxicity during chemotherapy and hematopoietic stem cell transplantation. In this review, data dealing with aggressive and low-grade B-NHL were separately analyzed. The few retrospective papers reporting on aggressive B-NHL patients showed that HCV infection is a risk factor for the outbreak of severe HT during treatment. This adverse event not infrequently leads to the reduction of treatment density and intensity. Existing papers report that low-grade B-NHL patients with HCV infection may have a more widespread disease, more frequent relapses or a lower ORR compared to HCV-negative patients. Notwithstanding, there is no statistical evidence that the prognosis of HCV-positive patients is inferior to that of HCV-negative subjects. HCV-positive prospective studies and longer follow-up are necessary to ascertain if HCV-positive B-NHL patients have inferior outcomes and if there are long term sequels of immunochemotherapies on the progression of liver disease.

Keywords: Marginal zone lymphoma; Diffuse large B cell lymphoma; Hepatitis C virus; Non-Hodgkin’s lymphomas; Hepatotoxicity; Chemotherapy; Immunochemotherapy; Prognosis; Rituximab