The association between the hepatitis C virus (HCV) and B-cell non-Hodgkin lymphomas (NHL) confirmed by epidemiological and therapeutic data. Most common association found with marginal zone lymphoma (MZL) and chronic HCV infection. A large number of studies have demonstrated that antiviral therapy (AT) with interferon (IFN) and ribavirin (RBV) can cause a high frequency of remission in HCV-associated indolent B-cell NHL. However, there were limited data about anti-tumor activity of the new direct-acting antiviral agents (DAAs) in the treatment of HCV+ MZL.
The aim of our report is the description of 2 patients HCV+ MZL, relapsed after IFN therapy and successful treated with DAAs.
31 patients (pts) with HCV+ MZL treated by IFN + RBV as the first-line therapy from 2005-2018. Median follow-up was 52 months. The relapse of lymphoma developed in 6 pts (19%), median duration of response was 38 months. We observed 2 women 41 and 58 years that had HCV infection (genotype 1b) more than 120 months before the clinical manifestation of lymphoma. The first patient had splenic MZL, the second patient diagnosed of disseminated variant with multiple nodal and extranodal (bone marrow, orbit, liver, soft tissue) involvement. IHC detected HCV protein expression on the tumor cells. Lymphoma and HCV remission achieved on 6- and 8-months INF+RBV therapy. The treatment interrupted after 24 and 28 months due to adverse events (fewer, redness, rash and swelling of the injection site). Blood examination was detected of neutralizing antibodies to interferon. After the end of the treatment the patients had a relapse of lymphoma on 18 and 23 months
At that time the remission of HCV continued. Re-biopsy were confirmed MZL, ICH again detected HCV protein expression on the tumor cells of both patients, in the blood neutralizing antibodies to interferon were present. Patients were treated with «interferon-free» antiviral regimen: ledipasvir 90 mg and sofosbuvir 90 mg per day. MZL complete remission achieved after 3 and 5 months of therapy. Antiviral therapy was continued 6 and 8 months.
Conclusion: Antiviral therapy is the preferred first-line option in patients with HCV-associated MZL. The use of new direct-acting antiviral agents is effective in the relapse of the disease. However, the duration of antiviral therapy should be 6 months or longer but these data require further study.