1,721,059 research outputs found
Hepatitis C Virus–Associated Non-Hodgkin Lymphomas: Biology, Epidemiology, and Treatment
No full textEradication of hepatitis C virus (HCV) in indolent non-Hodgkin lymphomas (NHLs), especially in marginal zone lymphomas, determines the regression of the hematologic disorder in a significant fraction of cases. Because direct antiviral agents show an excellent profile in terms of efficacy, safety, and rapid onset of action, these drugs can be used in any clinical situation and in the presence of any comorbidities. To avoid the progression of the NHL, despite HCV eradication, antiviral therapy should be provided as soon as the viral infection is discovered; before that, the chronic antigenic stimulation determines the irreversible proliferation of neoplastic B cells
HCV and lymphoproliferative disorders
No full textThe etiology of non-Hodgkin's lymphomas (NHL) remains a controversial matter, but, in the last few years, considerable evidence suggests that aberrations of the immune system and viruses may act as etiologic agents, in at least some cases of NHL. In fact, patients with primary immuno-deficiencies, or those suffering from diseases characterized by autoimmune dysfunction, show an increased risk for the development of NHL. Several viruses have been identified as possible etiologic agents for NHL; one of the best studied is the Epstein-Barr virus, which was detected in cultures of tumor cells from patients with Burkitt's lymphoma. The pathogenetic potential of this virus is illustrated by its association with an increasing number of malignant diseases. In addition, the human T-cell lymphotropic virus family (HTLV), was also recognized as possible etiologic agents for several lymphomas, such as cutaneous T-cell lymphoma and T-cell leukemia-lymphoma syndrome (HTLV-I), and T-cell hairy cell leukemia (HTLV-II). Recently, the presence of hepatitis C virus infection has also been recognized in several hematological malignancies such as mixed cryoglobulinemia, low-grade malignant lymphomas and Waldenström's disease. The possible etiopathogenetic role of this virus in non-Hodgkin's lymphomas is discussed on the basis of molecular, clinical, and epidemiological considerations
Hepatitis C virus, mixed cryoglobulinemia and non-Hodgkin’s lymphoma
No full textThere is increasing evidence from recent studies that a
large number of diseases are related to infections. In the
field of haematology, many malignant disorders are now
related to some infectious agents, such as Epstein-Barr
virus (EBV) in Burkitt's lymphoma, human T lymphocyte
virus I (HTLV-I) in T-cell leukaemia-lymphoma,
Helicobacter pylori in gastric B-cell lymphoma, human
herpes virus (HHV-6, -7, -8) in Kaposi's sarcoma and
Castelman's disease and, perhaps, parvovirus B19 in pure
red cell aplasia. However, all these infectious agents are
widespread in the general population, but only a very small
fraction of infected patients develop the neoplastic disease,
indicating the crucial role of some, at present unknown,
underlying genetic factors.
An association between HCV infection and B-cell
lymphoma has been demonstrated in several geographical
areas. Although controversy remains, a pathogenetic
linkage between HCV and NHL is strongly suggested by
molecular and epidemiological evidence. However, despite
this evidence, the pathogenetic mechanisms underlying
HCV-associated lymphomas are still unknown. HCV-related
lymphomas could, therefore, represent an important model
for analysing virus–induced lymphomas in humans.
It has not been elucidated whether HCV exerts its
oncogenic effect through an indirect mechanism or whether
it uses other pathways directly. It can be said that in most
cases the viral infection does not have a significant impact
on either response to chemotherapy or survival of
lymphoma patients. Chemotherapy is relatively safe and
treatment regimes do not usually need to be interrupted.
Since the treatment of HCV infection can lead to
regression not only of chromosomal and molecular
abnormalities, but even of clinically evident low-grade
NHL118.119, new therapeutic strategies (pegylated interferons
plus ribavirin), currently recognised as the gold standard
for HCV antiviral therapy and able to eradicate HCV in a
high percentage of treated subjects (from 60 to 90% of
complete responders on the basis of HCV genotype: 1 vs.
non-1) are likely to drastically reduce the number of HCV
infected patients and, consequently, the number of HCVrelated
NHL
Recent news in the treatment of hepatitis B virus-related cryogobulinemic vasculitis
No full textHepatitis B virus (HBV) is a hepatotropic virus that causes hepatitis, cirrhosis and hepatocellular carcinoma. Twenty percent of HBV patients may develop extra-hepatic manifestations, such as polyarthritis nodosa, glomerulonephritis, dermatitis, poly-arthralgia and arthritis, and aplastic anemia. The association of HBV and cryoglobulinemic vasculitis (CV) has been highlighted by several epidemiological investigations. CV can develop in 0.5- 4% of HBV infected patients.
It has been demonstrated that suppression of HBV replication by nucleot(s)ide analogues (NAs) effectively induces clinical response in most patients with mild to moderate CV, but low responses are seen in severe CV. Based on this evidence, NAs therapy represents the first line therapeutic option in subjects with mild or moderate HBV related CV. Peg-interferon-Alfa can be an alternative treatment for HBV related CV, but the few studies published so far have shown no encouraging results.
In patients with severe vasculitis and/or skin ulcers, peripheral neuropathy and glomerulonephritis treatment with rituximab (RTX) and NAs should be considered as a first line treatment.
The long-term administration of low-medium glucocorticoid doses has been widely used in few studies to control clinical symptoms, but it should be used as a second option, when RTX is ineffective or not tolerated and in association with NAs. This review focuses on novel treatments for HBV related CV
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