Successful treatment by on-demand glecaprevir and pibrentasvir for hepatitis C flare during R-CHOP in patients with diffuse large B-cell lymphoma: a case report

Machiko Umemura; Goki Suda; Shihori Tsukamoto; Ko Ebata; Shinjiro Takahash; Takashi Sasaki; Sae Nakajima; Koji Hirata; Mariko Ozasa; Masatoshi Takano; Masaki Katagiri; Naoya Sakamoto

doi:10.1186/s12879-021-06091-x

Successful treatment by on-demand glecaprevir and pibrentasvir for hepatitis C flare during R-CHOP in patients with diffuse large B-cell lymphoma: a case report

BMC Infect Dis. 2021 Apr 27;21(1):389. doi: 10.1186/s12879-021-06091-x.

Authors

Affiliations

¹ Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan.
² Sapporo Hokuyu Hospital, Sapporo, Hokkaido, Japan. gsudgast@pop.med.hokudai.ac.jp.
³ Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan. gsudgast@pop.med.hokudai.ac.jp.
⁴ Department of Gastroenterology and Hepatology, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.

^# Contributed equally.

Abstract

Background: In patients with hepatitis C virus (HCV) and malignant lymphoma, hepatitis C flare during R-CHOP can result in discontinuation of treatment. However, appropriate therapeutic strategies for managing hepatitis C flare during R-CHOP have not been established, and this issue is complicated by conflicting results regarding the use of direct-acting antivirals in patients with uncontrolled malignancies.

Case presentation: We report the first case of effective and safe treatment with on-demand 8-week glecaprevir and pibrentasvir for hepatitis C flare during R-CHOP in a patient with diffuse large B-cell lymphoma (DLBCL). The patient completed five additional courses of R-CHOP without hepatic toxicity. A complete response of DLBCL and a sustained virological response were observed at 24 weeks after glecaprevir and pibrentasvir completion.

Conclusion: On-demand, direct-acting antivirals could be a novel strategy for managing hepatitis C flare during R-CHOP.

Keywords: Direct-acting antiviral, hepatitis C flare; Glecaprevir; Hepatitis C virus; Pibrentasvir.

Publication types

Case Reports

MeSH terms

Aminoisobutyric Acids / administration & dosage*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Antiviral Agents / administration & dosage*
Benzimidazoles / administration & dosage*
Cyclophosphamide / therapeutic use
Cyclopropanes / administration & dosage*
Doxorubicin / therapeutic use
Genotype
Hepacivirus / genetics*
Hepatitis C / complications*
Hepatitis C / drug therapy*
Humans
Lactams, Macrocyclic / administration & dosage*
Leucine / administration & dosage
Leucine / analogs & derivatives*
Lymphoma, Large B-Cell, Diffuse / complications*
Lymphoma, Large B-Cell, Diffuse / drug therapy*
Male
Middle Aged
Prednisone / therapeutic use
Proline / administration & dosage
Proline / analogs & derivatives*
Pyrrolidines
Quinoxalines / administration & dosage*
RNA, Viral / blood
RNA, Viral / genetics
Rituximab / therapeutic use
Sulfonamides / administration & dosage*
Sustained Virologic Response
Vincristine / therapeutic use
Viral Load / drug effects

Substances

Aminoisobutyric Acids
Antiviral Agents
Benzimidazoles
Cyclopropanes
Lactams, Macrocyclic
Pyrrolidines
Quinoxalines
R-CHOP protocol
RNA, Viral
Sulfonamides
pibrentasvir
Rituximab
Vincristine
Doxorubicin
Cyclophosphamide
Proline
Leucine
glecaprevir
Prednisone

Grants and funding

JP20fk0210072, JP20fk0210047/Japan Agency for Medical Research and Development