Background/Aim: A positive association between HCV and NHL is well known since 1994 and it has been suggested that HCV infection could influence outcome, determining a higher than expected incidence of hepatic toxicity during chemotherapy and causing patients to receive modified chemotherapy protocols, in terms of duration, dosages and composition, thus providing treatments below the standard of care. Despite the prevalence of HCV infection in NHL, little is known about acute exacerbation and reactivation of chronic HCV infection in patients with cancer. We aimed to study hepatitis flare (defined as ALT ≥ 3ULN) as a direct deleterious effect of R-CHOP protocol in NHL patients with current or previous HCV infection. Pathients and methods: Between June 2016 and May 2018, one hundred thirty five NHL patients (stage III & IV) with a positive antibody for HCV were included in the study with their ages ranging from 19-67 years and a mean of 47±10 years. Ninety four patients were HCV-ab positive/PCR positive (group A) and forty one patients were HCV-ab positive/PCR negative (group B) diagnosed with different subtypes of CD20-positive NHL were all exposed to R-CHOP protocol and ALT was tested before each cycle of chemotherapy and HCV RNA PCR was retested in patients who developed hepatitis flare, moreover; their next chemotherapy cycle was delayed for two weeks after which a decision for chemotherapy continuation, stoppage or dose modification was taken according to their ALT level, performance status and Child Pugh classification. Results: In group A hepatitis flare occurred in 6 patients out of 94 (6.4%); an event which was associated with increased HCV load, worsening of performance state and forcible stoppage of chemotherapy in 5 of them while the 6th patient continued his expected cycles of chemotherapy after 2 weeks delay and a 75% doxorubicin dose reduction; while in group B hepatitis flare occurred in 5 patients out of 41 (12.2%); an event which was associated with HCV reactivation, fulminant hepatitis and death in one patient and 2 weeks delay in chemotherapy protocol with dose modification in the other four patients who included one more case of HCV reactivation. There was no statistically significant difference between both groups as regards hepatitis flare (p=0.256), treatment delay (p=0.342), treatment stoppage (p=0.675) or dose modification (p=0.505). Conclusion: The R-CHOP protocol used for treatment of CD20-positive NHLs is associated with direct risk of development of hepatic flares in NHL patients, a biological event associated to an increase in HCV replication in some of them with no significant difference between HCV-RNA-PCR positive and negative groups. |
