JLE

Hématologie

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Hepatis C virus related non-Hodgkin’s lymphomas Volume 6, issue 2, Mars - Avril 2000

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Hepatitis C virus (HCV) is associated with extra-hepatic manifestations linked to autoimmune diseases and mixed cryoglobulinemia (MC). More than 90 % of patients with MC are infected by HCV. Since low-grade lymphomas often develop among patients with MC, the association between HCV and non-Hodgkin’s lymphomas (NHL) has been widely investigated. Most epidemiological studies on HCV and NHL have been done in Italy. In these studies, HCV prevalence among patients with NHL is estimated between 10 and 40 % compared to 1-7 % among control populations. Two studies in the United States and in Japan have also found such an association. In contrast, in Northern Europe, no epidemiological association has been found between HCV and NHL. However, the absence of a control group in some of these studies and/or a very low prevalence of HCV infection in these populations may have made difficult to find such an association. HCV related NHLs seem to have some particular characteristics. Most of them are low grade B-NHL frequently with extra-nodal involvement. HCV infection is more closely associated with immunocytomas, and marginal zone lymphomas (nodal, extra-nodal and particularly of the spleen). They are not necessarily associated with the presence of a cryoglobulin. Physio-pathological explanations for this association remain hypothetical. The chronicity of HCV infection induces chronic B-cell stimulation that may favour the occurrence of oncogenic mutations and thereby of NHL. Eradication of HCV by interferon therapy has been associated in reported cases with a good clinical response among patients with HCV associated NHL. This finding strongly suggests a causal association between HCV and NHL. Therefore, clinical trials of eradication of HCV to cure HCV related low grade NHL are warranted.