Abstract 2934

Poster Board II-910

Background:

hepatitis C virus (HCV) infection has been associated with increased risk of developing B-cell lymphoprolipherative disorders through chronic immune stimulation. Discordant data have been reported about the prevalence of HCV infection in patients with Waldenström's Macroglobulinemia (WM) and the putative role of HCV in lymphomagenesis of this non-Hodgkin Lymphoma subtype remains controversial.

Aim:

the current retrospective study was conducted to assess the impact of this infection itself in the clinical and biological features and outcome among WM patients as compared with those with HCV negative WM.

Patients and methods:

we analyzed 140 WM patients with tested anti-HCV antibody (HCV-Ab). HCV-Ab positivity was detected in 21 cases (15%).

Clinical characteristics of patients at diagnosis of WM are reported in the table below.

CharacteristicsAll patientsHCV-HCV+P
Age y median 63 63 65 0,495 
Sex % M/F 59/41 63/37 38/62 0,052 
Hb median g/dl 12,6 13 11,6 0,041 
PLT x 10 9/l median 238 250 207 0,028 
PMN x 10 9/l median 3,68 3,87 2,65 0,002 
IgM mg/dl median 2150 1796 2565 0,843 
Bone marrow infiltration %:     
 ≤30% 46 44 60 >0,999 
 30-80% 32 35 15 >0,999 
 ≥ 80% 22 21 25 >0,999 
LDH U/L median 313 304,5 401 0,029 
B2-M ug/mL median 2,46 2,4 3,65 0,045 
Albumine g/dL median 4,4 4,3 4,4 0,461 
Creatinine mg/dL median 0,9 0,9 0,9 >0,999 
Splenomegaly % 21 17 43 0,018 
Lymphadenopathy % 17 16 24 0,755 
Neuropathy % 11 9 19 0,248 
Presence of autoantibodies % 17 12 48 0,002 
Cryoglobulins % 15 9 48 0,004 
CharacteristicsAll patientsHCV-HCV+P
Age y median 63 63 65 0,495 
Sex % M/F 59/41 63/37 38/62 0,052 
Hb median g/dl 12,6 13 11,6 0,041 
PLT x 10 9/l median 238 250 207 0,028 
PMN x 10 9/l median 3,68 3,87 2,65 0,002 
IgM mg/dl median 2150 1796 2565 0,843 
Bone marrow infiltration %:     
 ≤30% 46 44 60 >0,999 
 30-80% 32 35 15 >0,999 
 ≥ 80% 22 21 25 >0,999 
LDH U/L median 313 304,5 401 0,029 
B2-M ug/mL median 2,46 2,4 3,65 0,045 
Albumine g/dL median 4,4 4,3 4,4 0,461 
Creatinine mg/dL median 0,9 0,9 0,9 >0,999 
Splenomegaly % 21 17 43 0,018 
Lymphadenopathy % 17 16 24 0,755 
Neuropathy % 11 9 19 0,248 
Presence of autoantibodies % 17 12 48 0,002 
Cryoglobulins % 15 9 48 0,004 
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Results:

HCV positivity was correlated to lower counts of platelets, neutrophil granulocytes, haemoglobin and with presence of cryoglobulins or autoantibodies and splenomegaly. Interestingly we even found a strong link between the presence of HCV and serum parameters of tumor burden such as beta-2 microglobulin (B2-M) and lactate dehydrogenase (LDH).

Furthermore we did not reveal any outcome implications in terms of disease progression needing treatment, time from diagnosis to first therapy, overall survival between HCV- and HCV+ patients.

Overall, 88 patients (63%) received treatment for disease progression with schedules including Rituximab in 46 cases (52% of treated patients). Rituximab was administered even in HCV-RNA positive patients associated to Cyclophosphamide and Fludarabine and this did not translate in hepatitis development. HCV-RNA was strictly monitored during immunotherapy and we did not observe any significant flair.

Conclusions:

in our series of patients HCV infection does not seem to affect clinical outcome of disease. Moreover, in our experience patients with documented infection can receive the same schedule of treatment including intensive chemotherapy even with monoclonal antibodies without development of further toxicity.

Disclosures:

No relevant conflicts of interest to declare.

Topics:
hepatitis c virus, waldenstrom macroglobulinemia, infections, autoantibodies, cryoglobulins, disease progression, hepatitis c, hepatitis c rna, rituximab, splenomegaly

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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