Impact of Antiviral HBV and HCV Treatment on Development of Haematological/Lymphoid Malignancies
Chronic HBV and HCV infections have significant implications on the management of patients with haematological malignancies. Screening for HBV and HCV is mandatory for any new diagnosis of a lymphoproliferative disorder. Antiviral treatment with nucleos(t)ide analogues is effective to prevent HBV reactivation in patients with haematological/oncological malignancies with either overt or occult HBV or HCV infection. Interestingly, regression of extranodal follicular lymphoma after effective anti-HBV therapy with lamivudine and entecavir in two HBsAg-positive patients has been described. This finding supports the hypothesis of an active role of HBV in lymphomagenesis.[95,96] Also fascinating are the data on the regression of NHLs after HCV eradication. Hermine and co-workers reported that antiviral therapy with sustained HCV clearance induced complete lymphoma response in 7 out of 9 patients with indolent lymphoma treated with IFN-α2b. Similarly, Vallisa et al demonstrated regression of low-grade B-NHL subtypes in 9 of 12 patients that eradicated HCV infection following treatment with peginterferon (peg-IFN) and ribavirin (RBV).
In a large series of HCV-associated indolent NHL, antiviral therapy with IFN or peg-IFN with or without RBV led to a sustained eradication of HCV in 80% of patients and regression of lymphoma in 77%. In addition, a recent meta-analysis including 254 patients reported an overall lymphoma response rate of 73% following HCV eradication. The advent of new direct-acting antivirals (DAAs) which can achieve SVR rates of 95%-100% with IFN-free, oral regimens open a new horizon in the management of lymphoproliferative disorders related to HCV infection. A sustained virological response and a lymphoproliferative disease response were obtained in 98% and 67%, respectively, of 45 patients with indolent B-cell NHLs after completing a course of DAA therapy. Only few, but encouraging, studies have been published on DAA therapy in patients with B-cell non-Hodgkin lymphoma.[98,100–104]
J Viral Hepat. 2019;27(1):4-12. © 2019 Blackwell Publishing