Originally published as JCO Early Release 10.1200/JCO.2005.01.5016 on January 17 2006

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Characteristics and Outcome of Diffuse Large B-Cell Lymphoma in Hepatitis C Virus–Positive Patients in LNH 93 and LNH 98 Groupe d'Etude des Lymphomes de l'Adulte Programs

From the Service d'Hématologie, Service d'Anatomo-Pathologie; Service d'Hépatologie, Hôpital Necker-Enfants Malades, APHP; Université René Descartes CNRS; Institut d'Hématologie, Hôpital Saint-Louis, INSERM ERM 0220, Paris; Service d'Hématologie, Hôpital Bicêtre, Le Kremlin Bicêtre; Département d'Information Hospitalier, Département de Pathologie; Hôpital Henri-Mondor, Créteil; Service d'hématologie, Hôpital de Lens; Service d'Hématologie, CHU Nancy Brabois; Département d'Immunologie, AZ Saint Jan, Brugge, Belgique; Service d'Hématologie, Centre Henri Becquerel, (Rouen); Service d'Hématologie, Centre Hospitalier Lyon Sud

Address reprint requests to Olivier Hermine, MD, PhD, Service d'Hématologie Adulte, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75743 Paris cedex 15, France; e-mail: hermine{at}necker.fr

PURPOSE: Epidemiologic studies show an association between hepatitis C virus (HCV) and B-cell non-Hodgkin's lymphoma (NHL). Treatment and outcome of patients with diffuse large-cell lymphoma (DLCL) and HCV infection are still a matter of debate.

PATIENTS AND METHODS: We studied the HCV-positive patients with B-cell DLCL included in the Groupe d'Etude des Lymphomes de l'Adulte (GELA) programs LNH 93 and LNH 98. They were compared with the other patients with DLCL included in these programs. HCV infection prevalence was 0.5% (26 of 5,586 patients).

RESULTS: Histologic types of HCV-positive DLCL were more frequently transformed from low-grade lymphoma than DLCL in HCV-negative patients (32% v 6%, P = .02). This is also supported by more frequent spleen involvement in HCV-positive patients (46% v 17%, P < .001). HCV-positive patients had more frequently elevated lactate dehydrogenase levels than other patients (77% v 55%, P = .02). Outcome of HCV-positive patients was poorer for overall survival (P = .02) but not for event-free survival (P = .13). After matching on age and prognosis factors, at 2 years of follow-up, the overall survival was 56% (95% CI, 33% to 76%) among HCV-positive patients, versus 80% (70% to 89%), and the event-free survival was 53% (33% to 72%) versus 74% (64% to 84%). The short-term hepatic toxicity of chemotherapy was strongly increased among HCV-positive patients. After exclusion of the two subjects with chronic hepatitis B virus infection, the overall proportion of subjects undergoing hepatic toxicity was 65% (15 of 23 patients).

CONCLUSION: HCV-positive patients with DLCL differ from other patients both at presentation and during chemotherapy. Specific protocols evaluating antiviral therapy should be designed for these patients.

Presented in part as a poster at the Annual Meeting of the American Society of Hematology, Philadelphia, PA, December 6-10, 2002.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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