Z Gastroenterol 2013; 51 - A45
DOI: 10.1055/s-0033-1347495

B-cell non-Hodgkin lymphoma (B-NHL) in patients with chronic hepatitis C. A report of 5 cases

I Nagy 1, A Pálvölgyi 1, S Modok 2, T Wittmann 1
  • 11st Department of Medicine, University of Szeged, Hungary
  • 22nd Department of Medicine, University of Szeged, Hungary

Background: Chronic hepatitis C virus (HCV) infection is well known as a cause of hepatocellular carcinoma, while B-NHL as the second-most-common malignancy related to this infection is less appreciated. B-NHL in chronic hepatitis C frequently, but not exclusively, develops in pts with cryoglobulinaemia, another haematological extrahepatic manifestation of HCV infection. We report here on 5 cases of B-NHL found in pts with chronic hepatitis C. Patients. Since 1993, B-NHL has been diagnosed in 5 HCV-infected pts (1 man and 4 women; age: 55 to 63 ys) treated and followed up in the Regional Hepatology Centre in Szeged. In 4 cases, the recognition of chronic HCV infection preceded the diagnosis B-NHL; 2 of them had unsuccessful previous antiviral treatment. Cryoglobulinaemia was present in 3 pts, one of them with membranoproliferative glomerulonephritis and chronic renal failure. The type of B-NHL was aggressive diffuse large B-cell lymphoma (DLBCL) in 2 cases, nodal marginal zone lymphoma in 1, and indolent B-cell lymphoma diagnosed from a bone-marrow biopsy in 2 cases. Outcomes. Because of the progression of their haematologic disease, all 5 pts required chemotherapeutic treatment; 3 of them are currently in haematologic remission, while 2 courses of chemotherapy are ongoing. In one woman with marginal zone lymphoma, unsuccessful antiviral treatment was followed by chemotherapy because of the lymphoma progression. After successful completion of the chemotherapy, a second course of anti-HCV treatment with peginterferon plus ribavirin resulted in a sustained virological response; she is now free from HCV and in complete haematological remission. Conclusions: Besides other, better recognized HCV-related pathologies, B-NHL should also be borne in mind in the work-up and follow-up of HCV-infected patients. Chemotherapy and antiviral treatment can induce durable remission; thus, collaboration between hepatologists and haematologists is essential to optimize outcome in HCV-associated lymphomas.