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Interferon-free antiviral treatment in B-cell lymphoproliferative disorders associated with hepatitis C virus infection

Luca Arcaini, Caroline Besson, Marco Frigeni, Hélène Fontaine, Maria Goldaniga, Milvia Casato, Marcella Visentini, Harrys A. Torres, Veronique Loustaud-Ratti, Jan Peveling-Oberhag, Paolo Fabris, Roberto Rossotti, Francesco Zaja, Luigi Rigacci, Sara Rattotti, Raffaele Bruno, Michele Merli, Céline Dorival, Laurent Alric, Arnaud Jaccard, Stanislas Pol, Fabrice Carrat, Virginia Valeria Ferretti, Carlo Visco and Olivier Hermine

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  • RE: Interferon-free antiviral treatment in B-cell lymphoproliferative disorders associated with hepatitis C virus infection
    • Marco Frigeni, Hematology resident Department of Molecular Medicine, University of Pavia, Pavia, Italy
    • Other Contributors:
      • Luca Arcaini, Hematologist

    Thank you for your comment and for raising this important issue.
    We agree that response rates are strictly dependent on histological subtypes of lymphoma. In the interferon era, highest rates of lymphoma response were observed in patients with marginal zone lymphoma but lymphoma activity was reported also for other indolent histologies such as follicular lymphoma (FL) and lymphoplasmacytic lymphoma [2].
    Regarding the activity of new direct-acting antiviral agents (DAAs) in HCV-associated follicular lymphoma, beyond the two cases described in our article [1] another case of HCV-positive stage IV FL with a complete lymphoma response after DAAs has been recently reported [3]. Overall, these data may suggest that DAAs could be considered as a reliable frontline approach also for HCV-associated FL when there is no immediate need of conventional treatment. However,  further investigation is needed and prospective trial are eagerly awaited to confirm these findings.
    Finally, grade IIIb FL is generally treated as diffuse large B-cell lymphoma (DLBCL); therefore, despite the positive results of reported case, we do not recommend to treat HCV-associated grade IIIb FL with only DAAs as frontline anti-lymphoma therapy [4].

    References
    1. Arcaini L, Besson C, Frigeni M, et al.: Interferon-free antiviral treatment in B-cell lymphoproliferative disorders associated with hepatitis C virus infection. Blood 2016. Doi: 10.1182/blood-2016-05-714667
    2. Merli...

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    Conflict of Interest:
    None declared.
  • RE: Interferon-free antiviral treatment in B-cell lymphoproliferative disorders associated with hepatitis C virus infection
    • Jessica P.E. Davis, Gastroenterology Fellow University of Virginia
    • Other Contributors:
      • Craig Portell, Oncologist
      • Saher Sabri, Interventional Radiologist
      • Nicolas Intagliata, Hepatologist

    To the Editor,

    We read with great interest the recent article by Arcaini et al. [1] characterizing the response of B-cell lymphoproliferative disorders to treatment of Hepatitis C (HCV) with interferon-free regimens. In this series and others [2-5], there are limited data for patients with HCV and follicular lymphoma with only two cases published. Given the significant differences in lymphoproliferative disorder response rates (LDR) among different histological subtypes of lymphoma, more data is needed for each particular subtype to better predict response. We present a case of follicular lymphoma with sustained radiographic resolution after direct-acting antiviral therapy (DAAT).

    A patient with genotype 2 hepatitis C cirrhosis (Childs-Pugh A) presented with a 1.4 cm liver lesion on magnetic resonance imaging (MRI) of his abdomen. A repeat MRI two months later demonstrated increase in size and number of lesions with concern for rapidly progressive multifocal HCC. The case was reviewed at a multi-disciplinary tumor board meeting and empiric treatment with transcatheter arterial chemoembolization (TACE) was recommended and subsequently performed with injection of drug eluting beads with 100 mg of doxorubicin. During angiography, some lesions demonstrated atypical radiographic features for HCC and consequently a percutaneous biopsy was performed in the other lobe of the liver (not treated with TACE). Pathology revealed grade IIIb follicular lymphoma. S...

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    Conflict of Interest:
    None declared.