Direct-Acting Antivirals in Hepatitis C Virus-Associated Diffuse Large B-cell Lymphomas.

Area of Science:

• Hepatology
• Oncology
• Virology

Background:

• Hepatitis C virus (HCV)-associated diffuse large B-cell lymphoma (DLBCL) presents significant therapeutic challenges, particularly concerning hepatic toxicity during immune-chemotherapy (I-CT).
• Direct-acting antivirals (DAAs) offer a new opportunity for HCV eradication alongside or after first-line I-CT.

Purpose of the Study:

• To evaluate the hematological, virological, and survival outcomes of HCV-positive DLBCL patients treated with DAAs concurrently or sequentially with first-line I-CT.
• To assess the safety and efficacy of concurrent DAA administration during I-CT.

Main Methods:

• Retrospective analysis of 47 HCV-positive DLBCL patients from 23 Italian and French centers.
• Patients received DAAs either concurrently (n=9) or sequentially (n=38) with first-line I-CT (mainly R-CHOP-like).
• Outcomes assessed included complete response to I-CT, sustained virological response (SVR) to DAAs, adverse events, hepatic toxicity, and survival.

Main Results:

• 46 of 47 patients achieved complete response to I-CT.
• 96% of patients (45/47) achieved SVR, with 8/9 in the concurrent cohort and 37/38 in the sequential cohort.
• Concurrent DAA administration showed a significant advantage in preventing hepatic toxicity compared to sequential treatment, with only one patient experiencing toxicity versus 23 in the sequential group.

Conclusions:

• HCV eradication with DAAs, either concurrently or sequentially with I-CT, is beneficial for patients with HCV-positive DLBCL.
• Concurrent DAA and R-CHOP administration is feasible, effective, and preferable for preventing hepatic toxicity.
• The study supports the routine eradication of HCV with DAAs in all patients diagnosed with HCV-positive DLBCL.