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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2016; 22(38): 8447-8458
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8447
Antiviral therapy of hepatitis C as curative treatment of indolent B-cell lymphoma
Michele Merli, Giuseppe Carli, Luca Arcaini, Carlo Visco
Michele Merli, Division of Hematology, University Hospital Ospedale di Circolo & Fondazione Macchi, University of Insubria, 36100 Varese, Italy
Giuseppe Carli, Carlo Visco, Department of Cell Therapy and Hematology, San Bortolo Hospital, 36100 Vicenza, Italy
Luca Arcaini, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy
Author contributions: Merli M and Visco C made the research; all authors revised the manuscript and gave final inputs before submission.
Conflict-of-interest statement: Authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Carlo Visco, Department of Cell Therapy and Hematology, San Bortolo Hospital, Via Rodolfi 37, 36100 Vicenza, Italy. carlovisco@hotmail.com
Telephone: +39-444-753626 Fax: +39-444-753626
Received: June 1, 2016
Peer-review started: June 2, 2016
First decision: July12, 2016
Revised: August 2, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: October 14, 2016
Abstract

The association of hepatitis C virus (HCV) and B-cell non-Hodgkin lymphomas (NHL) has been highlighted by several epidemiological and biological insights; however the most convincing evidence is represented by interventional studies demonstrating the capability of antiviral treatment (AT) with interferon (IFN) with or without ribavirin to induce the regression of indolent lymphomas, especially of marginal-zone origin. In the largest published retrospective study (100 patients) the overall response rate (ORR) after first-line IFN-based AT was 77% (44% complete responses) and responses were sustainable (median duration of response 33 mo). These results were confirmed by a recent meta-analysis on 254 patients, demonstrating an ORR of 73%. Moreover this analysis confirmed the highly significant correlation between the achievement of viral eradication sustained virological response (SVR) and hematological responses. Two large prospective studies demonstrated that AT is associated with improved survival and argue in favor of current guidelines’ recommendation of AT as preferential first-line option in asymptomatic patients with HCV-associated indolent NHL. The recently approved direct-acting antiviral agents (DAAs) revolutionized the treatment of HCV infection, leading to SVR approaching 100% in all genotypes. Very preliminary data of IFN-free DAAs therapy in indolent HCV-positive NHL seem to confirm their activity in inducing lymphoma regression.

Keywords: Non-hodgkin lymphomas, Hepatitis C virus, Antiviral therapy, Interferon, Ribavirin, Sofosbuvir, Direct-acting antiviral agents, Marginal zone lymphomas

Core tip: In the last decade many clinical studies demonstrated that front line antiviral therapy (AT) with interferon (IFN) and ribavirin, is able to induce a 70%-75% response rate in patients with hepatitis C virus (HCV)-associated indolent non-Hodgkin lymphoma who do not need immediate conventional treatment. Hematological response was durable, and invariably related to the viral eradication. International guidelines indicate that AT should be the treatment of choice in such patients. Very preliminary data about the use of the new direct-acting antiviral agents (DAAs) suggest a similar activity in inducing lymphoma response. We discuss available literature about IFN-based AT and preliminary experiences with DAAs in the treatment of HCV-associated indolent lymphomas.