57 Nevertheless, hepatotoxicity during lymphoma therapy appears less of a problem with HCV than HBV reactivation. Clearly, this is an area in which further study is required to prevent unnecessary dose reductions, regimen modifications, or chemotherapy cessation while balancing

Dorsomorphin research buy hepatotoxicity risk that might be severe or even fatal.39, 40 Management of hepatotoxicity is also key, because stopping or delaying treatment may translate into poorer overall survival (OS). Arcaini et al.55 reported a shorter median progression-free survival (2 years versus 3.7 years) for patients who experienced hepatotoxicity. Arcaini et al.55 and Besson et al.39 reported a decreased OS (56% versus 80%) for HCV-positive patients versus negative patients at 2 years follow-up, attributed in part to the impact of hepatotoxicity, which led to the death of three patients. However, this drop in survival was not seen by Ennishi et al.,40 who found that HCV infection was not an adverse prognostic factor despite significant levels of hepatotoxicity (27% of patients), with a 3-year progression-free survival of 69% versus 77% (P = 0.22) and OS of 75% versus 84% (P = 0.07). Significant immunosuppression may also change the tempo of

HCV natural history and accelerate complications such as cirrhosis, as seen in HCV-infected allogeneic bone marrow transplant recipients.58 Based on the current literature, it is therefore advisable that patients with HCV and lymphoma are monitored for hepatotoxicity and that appropriate specialist learn more referrals are made for the management of infection throughout lymphoma treatment, Etofibrate with hepatologists and oncologists working closely together to optimize outcome. With the growing realization

that HCV may be responsible for a higher lymphoma prevalence, research efforts have moved toward prognostication and prevention. A new HCV prognostic score was recently presented that attempts to differentiate between three risk categories (low, intermediate, and high) and ascribe a numerical score according to specific factors.59 The group from Italy studied HCV-positive B-NHL, and their multivariate analysis on 1,043 patients identified three factors associated with poorer OS: Eastern Cooperative Oncology Group score ≥2, HCV-RNA >106 IU/mL and serum albumin <3.5 g/dL. There is also evidence to show that antiviral therapy may prevent lymphoma development in HCV-positive patients. Zuckerman et al.60 demonstrated the correlation of antiviral treatment response with elimination of either t(14;18) or immunoglobulin H rearrangements in HCV patients. Not all groups have confirmed these findings, however.44, 46 It is not yet known, therefore, whether t(14;18) is a neoplastic marker in HCV-positive patients, as some have experienced concurrent “molecular” and clinical remissions in response to antiviral therapy, whereas others have only achieved clinical remissions.