Department of Molecular Medicine, University of Pavia, Pavia; Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia.
Division of Hematology, Ospedale Giovanni da Saliceto, Piacenza.
Ann Oncol. 2014 Jul;25(7):1404-1410. doi: 10.1093/annonc/mdu166. Epub 2014 May 5.
Tumor regression after antiviral therapy (AT) is in favor of an etiological role of hepatitis C virus (HCV) in non-Hodgkin's B-cell lymphomas (NHL).
We carried out a cohort study of 704 consecutive HIV-negative, HCV-positive patients with indolent NHL diagnosed and treated from 1993 to 2009 in 39 centers of the Fondazione Italiana Linfomi; 134 patients were managed with AT for lymphoma control.
For entire cohort, 5-year overall survival (OS) was 78% [95% confidence interval (CI): 74%-82%] and 5-year progression-free survival (PFS) was 48% (95% CI: 44%-53%). In multivariate analysis, the use of AT during the patients' life had positive impact on OS. Forty-four of the 100 patients treated with first-line AT achieved a complete remission (CR) and 33 a partial response (PR). HCV-RNA clearance was achieved in 80 patients and was related to lymphoma response. At a median follow-up of 3.6 years, 5-year PFS was 63% (95% CI: 50%-73%). CR + PR rate was 85% with AT as second-line treatment.
AT produces HCV-RNA clearance and consequent tumor regression in most patients with HCV-related indolent NHL. AT used at any time is associated with improved OS. Consequently, AT can be considered an option for patients with indolent lymphomas who do not need immediate cytoreductive treatment.
抗病毒治疗（AT）后肿瘤消退有利于丙型肝炎病毒（HCV）在非霍奇金 B 细胞淋巴瘤（NHL）中的病因作用。
我们对 1993 年至 2009 年期间在意大利淋巴瘤基金会的 39 个中心诊断和治疗的 704 例连续 HIV 阴性、HCV 阳性、惰性 NHL 患者进行了队列研究；134 例患者接受 AT 治疗以控制淋巴瘤。
对于整个队列，5 年总生存率（OS）为 78%[95%置信区间（CI）：74%-82%]，5 年无进展生存率（PFS）为 48%（95%CI：44%-53%）。在多变量分析中，患者一生中使用 AT 对 OS 有积极影响。100 例接受一线 AT 治疗的患者中有 44 例达到完全缓解（CR），33 例达到部分缓解（PR）。80 例患者获得 HCV-RNA 清除，与淋巴瘤反应有关。在中位随访 3.6 年后，5 年 PFS 为 63%（95%CI：50%-73%）。用 AT 作为二线治疗，CR+PR 率为 85%。
AT 可使 HCV-RNA 清除并导致大多数 HCV 相关惰性 NHL 患者的肿瘤消退。任何时候使用 AT 均与 OS 改善相关。因此，AT 可作为不需要立即细胞减灭治疗的惰性淋巴瘤患者的一种选择。
