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.

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