- HCV treatment with direct-acting antivirals (DAAs) is safe and effective when given either during or after first-line immunochemotherapy (ICT) for diffuse large B-cell lymphoma (DLBCL).
Why this matters
- International guidelines recommend that DAAs follow ICT, based on limited evidence.
- The current study supports concurrent or subsequent DAA administration.
- French/Italian multicenter study of 47 consecutive patients with HCV+ DLBCL receiving DAA therapy with (n=9) or after (n=38) first-line ICT.
- DAA regimens selected based on genotype; 45/47 sofosbuvir-based.
- ICT was mainly rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)-like.
- Funding: Fondazione Regionale Ricerca Biomedica, Fondazione Matarelli, Fondazione Rusconi, AIL Varese ONLUS.
- Median patient age, 61 years; stage III/IV DLBCL, 89%; advanced fibrosis, 40%; cirrhosis, 25%.
- HCV-1 (56%) and HCV-2 (34%) were most common.
- 46/47 patients (97.9%) achieved complete response to ICT.
- 45/47 patients (95.7%) achieved sustained virologic response at 12 weeks posttherapy (SVR12).
- Concurrent DAAs, 88.9%.
- Sequential DAAs, 97.4%.
- DAAs were well-tolerated; 11 patients (23.4%) reported grade 1/2 adverse events.
- Hepatotoxicity was lower with concurrent vs sequential DAA therapy (1 case [12.5%] vs 23 cases [61%]; grade 3/4, n=7).
- 2-year progression-free and overall survival rates were 93.1% and 97.4%, respectively.
- Clinician selection of DAA timing.