Outcome prediction of diffuse large B-cell lymphomas associated with hepatitis C virus infection: a study on behalf of the Fondazione Italiana Linfomi

Abstract

A specific prognostication score for hepatitis C virus-positive diffuse large B-cell lymphomas is not available. For this purpose, the Fondazione Italiana Linfomi (FIL, Italian Lymphoma Foundation) carried out a multicenter retrospective study on a large consecutive series of patients with hepatitis C virus-associated diffuse large B-cell lymphoma to evaluate the prognostic impact of clinical and virological features and to develop a specific prognostic score for this subset of patients. All prognostic evaluations were performed on 535 patients treated with an anthracycline-based induction regimen (with rituximab in 255 cases). Severe hepatotoxicity was observed in 14% of patients. The use of rituximab was not associated with increased rate of severe hepatotoxicity. Three-year overall survival and progression-free survival were 71% and 55%, respectively. At multivariate analysis, ECOG performance status of 2 or over, serum albumin below 3.5 g/dL and HCV-RNA viral load over 1000 KIU/mL retained prognostic significance. We combined these 3 factors in a new "HCV Prognostic Score" able to discriminate 3 risk categories with different overall and progression-free survival (low=0; intermediate=1; high-risk ≥2 factors; P<0.001). This score retained prognostic value in the subgroups of patients treated with and without rituximab (P<0.001). The new score performed better than the International Prognostic Index at multivariate analysis and Harrel C-statistic. With the use of three readily available factors (performance status, albumin level and HCV-RNA viral load), the new "HCV Prognostic Score" is able to identify 3 risk categories with different survival, and may be a useful tool to predict the outcome of hepatitis C virus-associated diffuse large B-cell lymphomas.

Figure 1.

OS and PFS of 535 patients with HCV-positive DLBCL treated with curative-intent therapy (panels A and B); OS and PFS in 252 patients with HCV-positive DLBCL treated with R-CHOP (panels C and D).

Figure 2.

OS according to HCV prognostic score (HPS) categories (A); PFS according to HCV prognostic score (HPS) categories (B) (171 patients).

Figure 3.

OS according to HCV prognostic score (HPS) categories in the subgroup of patients treated with R-CHOP (A); PFS according to HCV prognostic score (HPS) categories in the subgroup of patients treated with R-CHOP (B); OS according to HCV prognostic score (HPS) categories in the subgroup of patients treated with CHOP (C); PFS according to HCV prognostic score (HPS) categories in the subgroup of patients treated with CHOP (D).