Chronic hepatitis C and B-cell non-Hodgkin's lymphoma

Hepatitis C virus (HCV), a hepatotropic and lymphotropic virus, is themajor causative agent of nonA-nonB chronic hepatitis; moreover, it isfrequently associated with benign and malignant lymphoproliferativedisorders such as mixed cryoglobulinaemia and B-cell non-Hodgkin's lymphoma(NHL). We investigated the clinical and virological features of B-cell NHLcomplicating chronic hepatitis C in a series of 10 patients (M/F 1/9; meanage 63 +/- 6SD years). The malignancy appeared after median 8 +/- 4SD yearsfrom onset and was low-grade in six patients, intermediate in three, andhigh-grade in one. 'One-tube nested' PCR detected serum HCV RNA and viralongoing replication in both fresh and cultured peripheral lymphocytes inall ten. Analysis of HCV genotypes showed a relatively higher prevalence of2a/III type compared with unselected chronic hepatitis C (50% vs. 15%). Inone patient, HCV RNA was also found in the neoplastic bone marrow andlymph- node specimens. B-cell NHL can complicate chronic hepatitis C andaffect the overall prognosis of the disease. The increasing frequency ofchronic hepatitis C worldwide suggests that the actual prevalence of thiscomplication may be underestimated. Careful clinical work-up at diagnosisand during follow-up is particularly recommendable.