HCV Clearance Linked to Better Outcomes in African Americans with Aggressive Lymphoma

Clearance of hepatitis C virus (HCV) in African American patients with lymphoma, including those with aggressive B-cell non-Hodgkin lymphoma (B-NHL), is associated with improved outcomes, according to a poster presented at the American Society of Hematology Annual Meeting and Exposition.

Direct-acting antiviral (DAA) HCV therapy results in high rates of sustained viral response and HCV cure. DAAs have been associated with regression of indolent lymphoma, especially marginal zone lymphoma, but the effect on aggressive B-NHL has been unclear, according to study author Sanjal Desai, MD.

“There are no data on outcomes for HCV-associated B-NHL in African American patients,” Desai noted in his presentation.

For the study, the authors aimed to evaluate lymphoma characteristics and outcomes in HCV-associated B-NHL in a predominantly African American population. They retrospectively studied patients with lymphoma and HCV diagnosed and treated at Medstar Washington Hospital Center, in Washington, DC between January 2003 and December 2017. Study outcomes included overall response rate (ORR), complete response rate (CR), overall survival (OS), and progression-free survival (PFS).

The study included 397 patients with lymphoma, 40 of whom also had HCV. A total of 38 patients had complete lymphoma and antiviral treatment history available and were included in the analysis.

Overall, median OS was not reached in patients who achieved virologic clearance, which was statistically significantly better than median OS of 89 months in patients who did not achieve virologic clearance, according to Desai.

Patients who achieved virologic clearance had statistically significantly higher ORRs (95% versus 69%, RR 2.4, CI₉₅ 1.3-4.4, p<0.05) and CR (73% vs 38%, 2.29, CI₉₅ 1.1-5.0.0, p<0.05), compared with patients without virologic clearance. Additionally, patients with diffuse large B-cell lymphoma and high-grade lymphoma with virologic clearance of HCV had statistically significantly higher CR rates (100% versus 46% and 100% versus 45% respectively, p<0.05). ORR was also higher in these subgroups, but the difference was not statistically significant, Desai said.

Desai concluded that HCV virologic clearance is associated with improved CR and OS in predominantly African American patients with lymphoma. However, the precise role and timing of HCV antiviral therapy in HCV-associated aggressive B-NHL needs further assessment in a large prospective study that includes African American patients.

Reference

• Desai S, Fernandez S, Vakiti A, et al. Virologic clearance of hepatitis C is associated with improved outcomes in African American patients with lymphoma [abstract 1614]. Presented at: American Society of Hematology Annual Meeting and Exposition. December 7-10, 2019. Orlando, Florida.