Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy.
Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy.
J Hepatol. 2015 Jan;62(1):234-7. doi: 10.1016/j.jhep.2014.09.031. Epub 2014 Oct 5.
Chronic infection with hepatitis C virus (HCV) may lead to B cell activation and transformation into non-Hodgkin lymphoma (NHL). Molecular mechanisms of B cell transformation by HCV are poorly understood. One of the most common lymphoproliferative disorders in HCV-infected patients is splenic marginal zone lymphoma (SMZL). A case of a 42-years old man, affected by HCV-related SMZL, effectively treated with an IFN-free, NS3-NS4A inhibitor-based regimen, is hereby described. The patient was treated for 16 weeks with faldaprevir, deleobuvir, and ribavirin, achieving a very rapid viral eradication without relevant toxicities. A rapid haematologic response was noted as well, with a statistically significant correlation between viral decay and lymphocyte improvement (coefficient r = 0.55, p = 0.042). The viral clearance led to SMZL cure, even without the use of IFN. Thus, the causative role, played by HCV in SMZL development, is once again reinforced, whereby the antiviral, rather than the anti-proliferative activity of IFN is indirectly proven. A regimen including DAAs should be considered when treating a HCV-related extra-hepatic disease.
慢性丙型肝炎病毒 (HCV) 感染可导致 B 细胞激活和转化为非霍奇金淋巴瘤 (NHL)。HCV 导致 B 细胞转化的分子机制尚不清楚。在 HCV 感染患者中，最常见的淋巴增殖性疾病之一是脾边缘区淋巴瘤 (SMZL)。本文描述了一例 HCV 相关 SMZL 患者，该患者接受了无干扰素、基于 NS3-NS4A 抑制剂的方案治疗，效果显著。该患者接受了 16 周的法地拉韦、德拉韦布和利巴韦林治疗，实现了非常快速的病毒清除，且无相关毒性。同时观察到快速的血液学反应，病毒衰减与淋巴细胞改善之间存在显著的统计学相关性 (系数 r = 0.55，p = 0.042)。病毒清除导致 SMZL 治愈，甚至无需使用干扰素。因此，HCV 在 SMZL 发展中的致病作用再次得到证实，这表明 IFN 的抗病毒而非抗增殖活性是间接的。在治疗 HCV 相关肝外疾病时，应考虑包含 DAA 的方案。
