Clinical and Chemical Pathology Department, Kasr Al Ainy Centre of Clinical Oncology & Nuclear Medicine, School of Medicine, Cairo University, Cairo, Egypt.
Gynecology & Obstetric Department, School of Medicine, Cairo University, Cairo, Egypt.
J Egypt Natl Canc Inst. 2020 Nov 27;32(1):43. doi: 10.1186/s43046-020-00054-0.
Multiple myeloma (MM) is a human B cell neoplasia characterized by the clonal proliferation of malignant plasma cells in the bone marrow. Worldwide, hepatitis C virus (HCV) infection is a public health problem. For MM patients, the clinical impact of preexisting HCV infection is still unclear. We aim to assess the clinical characteristics and the prevalence of the HCV infection in Egyptian MM patients. This observational study included 81 MM patients. HCV antibody assay was performed, and positive cases were confirmed using a reverse transcription-quantitative PCR (RT-PCR) method.
Fifteen (18.5%) patients were anti-HCV antibody positive. Only 6/15 (7.4%) patients were HCV RNA positive by RT-PCR. Liver affection in the form of hyperbilirubinemia with grade 4 adverse events was significantly higher in the anti-HCV positive/HCV RNA positive group versus anti HCV negative group (16.7% vs. 1.5%, p value = 0.005). The median HCV-RNA before the initiation of chemotherapy was 2.5 log IU/ml with mean ± SD = 4.25 ± 1.6 with no HCV reactivation. In the univariate and multivariate analysis, HCV infection was not an independent factor related to DFS. Low hemoglobin level < 10 g/dL (HR 0.59, 95% CI, 0.36-0.97, p value = 0.037) and abnormal serum total bilirubin level (HR 1.9, 95% CI 1.03-3.5, p value = 0.039) influenced DFS in the univariate analysis. However, in the multivariate analysis, serum calcium level greater than 12 mg/dL (HR 7.04, 95% CI 1.12-44.45, p value = 0.038) and abnormal serum total bilirubin level (HR 10.9, 95% CI 2.92-41.02, p value = < 0.001) remained statistically significant worse prognostic factors.
In conclusion, our study revealed the prevalence of HCV infection in Egyptian MM patients. Serologic tests at diagnosis are necessary to identify these patients, and confirmation of positive cases by molecular techniques should be mandatory, with regular follow-up for liver dysfunction. Finally, further larger studies explaining the molecular mechanisms linking HCV and the MM pathogenesis are warranted.
多发性骨髓瘤（MM）是一种人类 B 细胞肿瘤，其特征是骨髓中恶性浆细胞的克隆性增殖。在全球范围内，丙型肝炎病毒（HCV）感染是一个公共卫生问题。对于 MM 患者，先前存在的 HCV 感染的临床影响尚不清楚。我们旨在评估埃及 MM 患者的 HCV 感染的临床特征和流行情况。这项观察性研究纳入了 81 例 MM 患者。进行了 HCV 抗体检测，并用逆转录定量 PCR（RT-PCR）方法对阳性病例进行了确认。
15 例（18.5%）患者 HCV 抗体阳性。仅 6/15（7.4%）例患者 HCV RNA 阳性，经 RT-PCR 证实。在 HCV 阳性/HCV RNA 阳性组中，以胆红素升高为表现的肝脏损害（4 级不良事件）显著高于 HCV 阴性组（16.7%比 1.5%，p 值=0.005）。化疗前 HCV-RNA 的中位数为 2.5 log IU/ml，平均值±标准差=4.25±1.6，无 HCV 再激活。在单因素和多因素分析中，HCV 感染不是与 DFS 相关的独立因素。低血红蛋白水平<10 g/dL（HR 0.59，95%CI，0.36-0.97，p 值=0.037）和血清总胆红素水平异常（HR 1.9，95%CI 1.03-3.5，p 值=0.039）在单因素分析中影响 DFS。然而，在多因素分析中，血清钙水平>12 mg/dL（HR 7.04，95%CI 1.12-44.45，p 值=0.038）和血清总胆红素水平异常（HR 10.9，95%CI 2.92-41.02，p 值=<0.001）仍然是统计学上较差的预后因素。
总之，我们的研究揭示了埃及 MM 患者 HCV 感染的流行情况。在诊断时进行血清学检测以识别这些患者是必要的，并且应通过分子技术对阳性病例进行确认，并对肝功能进行定期随访。最后，需要进行进一步的更大规模的研究，以解释 HCV 与 MM 发病机制之间的分子机制。
