Divison of Hematology, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Viale Golgi 19, Pavia, Italy.
Am J Hematol. 2010 Jan;85(1):46-50. doi: 10.1002/ajh.21564.
We studied 160 Hepatitis C virus (HCV)-positive patients with NHL (59 indolent NHL, 101 aggressive). Median age was 67 years. HCV-RNA was present in 146. HBsAg was positive in seven patients. At diagnosis, ALT value was above UNL in 67 patients. One hundred and twenty patients received an anthracycline-based therapy, alkylators, 28 received chemotherapy plus rituximab. Cytotoxic drugs dose was reduced in 63 patients. Among 93 patients with normal ALT at presentation, 16 patients developed WHO grade II-III liver toxicity. Among 67 patients with abnormal ALT, eight patients had a 3.5 times elevation during treatment. Among 28 patients treated with rituximab and chemotherapy, five patients (18%) developed liver toxicity. Thirty four patients (21%) did not complete treatment (eight for liver toxicity). Median progression-free survival (PFS) for patients who experienced liver toxicity is significantly shorter than median PFS of patients without toxicity (respectively, 2 years and 3.7 years, P = 0.03). After a median F-UP of 2 years, 32 patients died (three for hepatic failure). A significant proportion of patients with HCV+ NHL develop liver toxicity often leading to interruption of treatment. This could be a limit to the application of immunochemotherapy programs. HCV+ lymphomas represent a distinct clinical subset of NHL that deserves specific clinical approach to limit liver toxicity and ameliorate survival.
我们研究了 160 例丙型肝炎病毒（HCV）阳性的 NHL 患者（59 例惰性 NHL，101 例侵袭性 NHL）。中位年龄为 67 岁。146 例患者 HCV-RNA 阳性。7 例患者 HBsAg 阳性。诊断时，67 例患者 ALT 值高于正常值上限。120 例患者接受了基于蒽环类药物的治疗、烷化剂治疗，28 例患者接受了化疗加利妥昔单抗治疗。63 例患者减少了细胞毒性药物剂量。在 93 例 ALT 正常的患者中，16 例出现了 WHO Ⅱ-Ⅲ级肝毒性。在 67 例 ALT 异常的患者中，8 例在治疗过程中出现了 3.5 倍的升高。在接受利妥昔单抗和化疗治疗的 28 例患者中，有 5 例（18%）发生了肝毒性。34 例（21%）患者未完成治疗（8 例因肝毒性）。发生肝毒性的患者的无进展生存期（PFS）明显短于无毒性患者的 PFS（分别为 2 年和 3.7 年，P=0.03）。在中位随访 2 年后，有 32 例患者死亡（3 例死于肝功能衰竭）。相当一部分 HCV+ NHL 患者会发生肝毒性，这常常导致治疗中断。这可能是免疫化疗方案应用的限制。HCV+淋巴瘤是 NHL 的一个独特临床亚型，需要特定的临床方法来限制肝毒性并改善生存。
