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Remission of Marginal Zone Lymphoma After HCV Eradication With New Direct Antiviral Agents.

To the Editor: Epidemiological studies have shown an association between chronic hepatitis C virus (HCV) infection and B-cell non-Hodgkin’s lymphoma (BNHL) development. We report the case of a 51-yearold man with chronic HCV infection, genotype 3, treatment naive, metavir score F3. In February 2015 he was referred to Haematology Department due to a painless submandibular tumefaction. A total body computed tomographic (CT) scan was performed and showed multiple cervical lymph nodes, the largest of which was 31 23mm. Histologic examination of lymph node fine needle aspiration biopsy revealed a B-NHL, subtype marginal zone lymphoma (MZL) (stage 1A). Before any other treatment, patient was referred to Gastroenterology Department where he started on treatment for HCV infection with sofosbuvir/ledipasvir (only available regimen) during 24 weeks. HCV viral load was undetectable at week 4 of treatment and so remained till the end of treatment. After the end of treatment, a total body CT scan was repeated for disease’ staging and revealed absence of lymphadenopathies or other lesions—remission of lymphoma after HCV infection treatment. HCV viral load 12 weeks after the end of treatment was undetectable. Currently patient remains asymptomatic without evidence of disease recurrence after almost 12 months of surveillance. B-NHL subtypes most frequently described as being associated with HCV infection are MZL and diffuse large B-cell lymphoma.1 The most convincing evidence for a causal relationship between HCV infection and lymphoma development is the observation of B-NHL regression after HCV eradication by antiviral therapy previously achieved with pegylated interferon (PEG-IFN) and ribavirin (RBV).1 Several studies have shown that complete hematologic response was closely correlated with virological response and that PEG-IFN/RBV therapy improves the overall and progression free survival.1–3 To our knowledge, this is the first case reported in literature of remission of MZL after HCV eradication with the single dose combination sofosbuvir/ ledipasvir. To date, 5 HCV-associated B-NHL treated with direct antiviral agents were reported. Three were MZL and 2 diffuse large B-cell lymphoma, 2 treated with sofosbuvir/simeprevir and 3 with sofosbuvir/daclastavir. Sustained virological response was obtained in all patients, and complete remission of NHL was noted 6 months after cessation of any treatment except for 1 patient.4 This case suggests that, as previously reported with PEG-IFN/ RBV, new direct antiviral agents might be a safe option as first-line treatment for HCV-associated indolent B-NHL with the precaution of enrolling these patients in a long-term follow-up.