Hepatitis C Infection Is Associated with Hepatic Toxicity but Does Not Compromise the Survival of Patients with Diffuse Large B Cell Lymphoma Treated with Rituximab-Based Chemotherapy

Introduction: The influence of hepatitis C virus (HCV) infection on outcome of patients with diffuse large B cell lymphoma (DLBCL) treated with rituximab-based chemotherapy is still controversial.

Materials and Methods: We retrospectively analyzed the characteristic and clinical outcomes of patients with DLBCL newly diagnosed between Jan 2005 and Dec 2011. All patients were treated with at least one course of rituximab-containing chemotherapy. The clinical characteristics between groups (29 HCV-positive or 139 HCV-negative) were compared using a Chi-square method for categorical variables, a Student’s t-test for continuous variables, and a non-parametric method (Wilcoxon Sum-Rank test) for AST, AST and total bilirubin. Univariate analysis followed by multivariate analysis was used to identify the variables associated with hepatotoxicity.

Results: The medium follow-up duration was 3.0 (0.07-8.02) years. HCV infection resulted in more hepatic toxicity in both univariate (55.2% vs. 23.0%, P = 0.001) and multivariate (P = 0.003) analyses. In addition, HCV-positive DLBCL patients were more likely to have treatment delay (20.1% vs. 0.7%, P = 0.004). For patients who developed hepatic toxicity during immunochemotherapy, HCV-positive patients had significantly higher folds of aspartate aminotransferase elevation (3.39 folds vs. 2.06 folds, P = 0.042) and total bilirubin elevation (1.60 folds vs. 0.96 folds, P = 0.012) compared with those who were HCV negative. However, HCV did not influence the 5-year progression-free survival rate (P = 0.412) or 5-year overall survival rate (P = 0.410).

Conclusions: HCV infection is associated with increased incidence and severity of hepatic toxicity and delayed chemotherapy without compromised survival in DLBCL patients treated with rituximab-based chemotherapy.