Direct-Acting Antivirals for Lymphoma?

Recent case reports indicate possible anti-lymphoma efficacy of direct-acting antivirals in patients with both lymphoma and hepatitis C.

Lymphoproliferative disorders have long been associated with hepatitis C virus (HCV) infection in epidemiologic studies. However, emerging evidence suggests that modern direct-acting antiviral treatments for hepatitis C may influence the course of lymphoma related to hepatitis C infection.

The mechanism for this relationship is thought to involve protein misfolding that is associated with cryoglobulinemia and cryoglobulinemic vasculitis, which occur in up to 15 percent of patients with chronic HCV infection.

In a recent case report published in the journal ACG Case Reports, researchers described a patient with splenic marginal zone lymphoma, chronic hepatitis C, and immune thrombocytopenia who experienced complete remission of all three conditions after treatment with the antivirals sofosbuvir and ribavirin.

Importantly, the patient did not receive chemotherapy for lymphoma.

Given that other types of lymphoma are associated with viral infections, such as Epstein-Barr virus, it is possible that future management strategies for some types of lymphoma will address some of the possible underlying viral infections associated with the pathogenesis of certain forms of this malignancy.

Because cases of lymphoma remission and cure have been recorded in patients with comorbid chronic HCV infection, it may be prudent to reserve chemotherapy in some cases until eradication of chronic HCV.

References

  • Lim LY, La D, Cserti-Gazdewich CM, Shah H. Lymphoma Remission by Interferon-Free HCV Eradication Without Chemotherapy. ACG Case Rep J. 2015;3(1):69-70.
  • Grywalska E, Rolinski J. Epstein-Barr virus-associated lymphomas. Semin Oncol. 2015;42(2):291-303.