Hepatitis C Infection Increases Risk of Lymphoma and Multiple Myeloma

Cancer Connect

by Dr. C.H. Weaver M.D. updated 6/2020

Several researchers have reported a relationship between Hepatitis C virus (HCV) infection and the risk of developing non-Hodgkin’s lymphoma (NHL) and multiple myeloma.

Infection with the HCV has been linked with chronic hepatitis, cirrhosis of the liver, and liver cancer. It is most commonly acquired through contact with infected blood. The infection can be spread by injection drug use, and has also been reported among individuals who received blood transfusions or organ transplants prior to widespread donor screening. An estimated 1.6% of the U.S. population is infected with HCV. Hepatitis C virus has also been found to be relatively prevalent in patients with some lymphomas and multiple myeloma. (1-3)

Non-Hodgkin’s lymphoma is a form of cancer that begins in the cells of the lymph system, which includes the spleen, thymus, tonsils, bone marrow, lymph nodes, and circulating immune cells. Lymphocytes are the main cells in the lymph system and exist in two forms: B- and T-cells. Each of these cells serves a specific function in aiding the body fight infection.

Because there is some evidence that HCV may increase the proliferation of cells in the lymph system, researchers have conducted studies to evaluate the risk of NHL and certain other types of cancer in individuals with and without HCV. In addition to NHL, the researchers collected information about Hodgkin’s lymphoma, leukemia, multiple myeloma, and thyroid cancer. The decision to include thyroid cancer was based on previous reports of a possible link with HCV.

One evaluation of 27,150 Swedish patients diagnosed with HCV between 1990 and 2000 from a national registry that was created to document all malignancies revealed that the risk of developing NHL and MM was significantly increased among patients with HCV. The association was not significant in thyroid cancer or CLL.

According to the results of another study published in the Journal of the American Medical Association, individuals who are infected with the hepatitis C virus are 20–30% more likely than non-infected individuals to develop non-Hodgkin’s lymphoma.

The study was conducted among a large sample of U.S. veterans. The study included 146,394 individuals with HCV and 572,293 individuals without HCV. Individuals infected with human immunodeficiency virus (HIV) were excluded. Most of the study participants were men, and their average age was 52 years.

  • HCV-infected individuals were 20–30% more likely to develop NHL than non-infected individuals.
  • The risk of a rare, slow-growing type of NHL known as Waldenström macroglobulinemia was almost three-times higher in HCV-infected individuals than in non-infected individuals.
  • HCV-infected individuals did not appear to have an increased risk of developing Hodgkin’s lymphoma, leukemia, multiple myeloma, or thyroid cancer.

According to another article published in The New England Journal of Medicine, patients with splenic lymphoma with villous lymphocytes who have the hepatitis C virus may derive anti-cancer benefit from treatment for the virus. (4)

Splenic lymphoma with villous lymphocytes is a slow-growing, or indolent, type of non-Hodgkin’s lymphoma. Non-Hodgkin’s lymphoma is a cancer of the lymph, or immune system. Lymphocytes are important cells of the immune system, of which there are several types. It is thought that splenic lymphoma with villous lymphocytes is a type of non-Hodgkin’s lymphoma that begins in the spleen. The slow growing cancerous lymphocytes grow and crowd the spleen and peripheral blood. Splenic lymphoma with villous lymphocytes is a relatively rare disease, with the average age of diagnosis being 70 years.

Some studies have suggested that there is an association between HCV and splenic lymphoma, which prompted researchers from France to conduct a clinical trial evaluating how antiviral therapy for HCV would affect the clinical course of splenic lymphoma in patients positive for HCV. (5)

In this trial, 9 patients with splenic lymphoma with villous lymphocytes who also had HCV were treated with interferon alfa, a standard anti-viral therapy for HCV. Following interferon treatment, 7 patients achieved a complete disappearance of cancer and HCV. The other two patients were treated with ribavirin, an additional anti-viral agent, in addition to interferon. One achieved a complete disappearance of cancer and the other achieved a partial disappearance of cancer. These researchers compared these results to those obtained from 6 other patients with splenic lymphoma with villous lymphocytes who did not have HCV, but were treated with interferon alfa. None of these patients responded to treatment.

These researchers concluded that anti-viral treatment with interferon alfa, with or without ribavirin, produces significant anti-cancer responses in patients with splenic lymphoma with villous lymphocytes who have HCV. The researchers stated that all patients with splenic lymphoma should be tested for HCV prior to the initiation of any therapy. All patients are encouraged to speak to their physician regarding their risk factors and appropriate disease screening and surveillance.

References:

  1. Duberg A, Nordstom M, Torner A, et al. Non-Hodgkin’s Lymphoma and Other Nonhepatic Malignancies in Swedish Patients with Hepatitis C Virus Infection. Hepatology. 2005;41: 652-659.
  2. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Annals of Internal Medicine. 2006;144:705-714.
  3. Giordano TP, Henderson L, Landgren O et al. Risk of non-Hodgkin lymphoma and lymphoproliferative precursor diseases in US veterans with hepatitis C virus. JAMA. 2007;297:2010-2017.
  4. The New England Journal of Medicine. 2002;347:89-94.
  5. Hermine O, Lefrere F, Bronowicki J-P, et al. Regression of splenic lymphoma with villous lymphocytes after treatment of Hepatitis C Virus infection.
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