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Hepatitis C virus infection in patients with B-cell lymphoproliferative disorders

Leukemia volume 16, pages 2162–2163 (2002)Cite this article

The role of HCV as a possible cause in the pathogenesis of lymphoproliferative disorders was prompted by the observations made on essential mixed cryoglobulinemia considered by some investigators to be a variant of low-grade B cell non-Hodgkin lymphoma (NHL). HCV RNA and antibodies to HCV (anti-HCV) have been found in up to 98% of patients with mixed cryoglobulinemia, and approximately 36% of patients with chronic HCV infection have mixed cryoglobulinemia. Regression of B cell expansion in HCV patients affected by cryoglobulinemia has also been reported in patients responsive to interferon therapy.1 It has also been demonstrated that HCV is both a hepatotrophic and a lymphotrophic virus, and that the persistence of HCV stimulation in these cells may chronically cause a clonal expansion eventually resulting in malignant B cell lymphoproliferative diseases. Several Italian studies,1 and more recently studies from North America2 have postulated a direct relationship between HCV infection and the development of these tumors. The overall prevalence of HCV evaluated in 2274 B cell non Hodgkin lymphoma patients reviewed by Silvestri, is 19.1%, and in almost half of those analysed an association with the production of cryoglobulins was present.2 Unfortunately, data from the United Kingdom,3 and more recently from Canada4 and France,5 did not confirm this hypothesis.

We determined prospectively the prevalence of HCV infection in patients with B cell lymphoproliferative diseases in a very homogeneous geographical population of Southern Italy where the prevalence of this infection is particularly elevated. The prevalence of hepatitis B infection and cryoglobulinemia were also investigated. Between September 1999 and October 2001, 60 consecutive patients (32 females and 28 males; median age 65 years, range 25–88 years) with B cell lymphoproliferative diseases (55 non-Hodgkin lymphoma and five multiple myeloma) were evaluated at the Division of Medical Oncology of the Oncology Institute of Bari (Italy). Over the same time period, 63 control patients with non-hematological malignancies were recruited from the Surgery Department of the same Institute. Patients were similar in the two groups studied with respect to age, sex, ethnicity; the prevalence of risk factors for HCV infection was slightly higher in the lymphoma group with respect to the control group. All patients were heterosexual, Caucasian and Italian-born. Details of risk factors for the acquisition of hepatitis C, including intravenous drug use, blood transfusions, surgical procedures, body piercing, tattoos and demographic characteristics were obtained from a questionnaire. Patients were also examined for signs of liver chronic disease. The diagnosis of lymphoproliferative diseases was determined in all cases on the basis of the histological analysis of a lymph node or extranodal tissues and bone marrow biopsy using the histological modified Working Formulation classification. Immunophenotypic analysis for surface B- and T- lymphocytic markers was also performed. Serological test included the study of the markers for HCV infection (antibodies HCV and HCV-RNA) and HBV infection (antibodies to hepatitis B surface antigen, hepatitis B surface antigen, antibodies hepatitis B core antigen, hepatitis B-e-antigen, antibody to hepatitis B-e-antigen). All markers of the hepatitis B virus and anti-HCV detected were tested with a third-generation microparticle enzyme immunoassay (MEIA). HCV-RNA detection was performed by a reverse-trascription polymerase chain reaction (RT-PCR) assay. For the statistical analysis the Fisher's exact test was employed whenever appropriate when comparing the different clinical, pathological and virological data in the two patient groups. The prevalence of anti-HCV, HCV RNA and cryoglobulinemia in the two groups are shown in Table 1.

Table 1 Prevalence of anti-HCV, HCV RNA and cryoglobulinemia in the two groups of patients
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Authors and Affiliations

  1. Division of Medical Oncology Istituto Oncologico, Bari, Italy

    M Guida, M De Lena & V Lorusso

  2. Hemato-immunology Laboratory, Istituto Oncologico, Bari, Italy

    G D'Elia, A Casamassima, G Micelli & M Quaranta

  3. Gastroenterology Unit, Policlinico, Bari, Italy

    S Benvestito & R Moschetta

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  1. M Guida
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Guida, M., D'Elia, G., Benvestito, S. et al. Hepatitis C virus infection in patients with B-cell lymphoproliferative disorders. Leukemia 16, 2162–2163 (2002). https://doi.org/10.1038/sj.leu.2402626

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