Non Hodgkin Lymphoma and Hepatitis C Virus in Egyptian Children: One Centre Study
DOI:
https://doi.org/10.12974/2312-5411.2014.01.02.5Keywords:
NHL, Egyptian children, HCV.Abstract
Non Hodgkin lymphoma (NHL) represents a major health problem in the world. In Egypt, where both, hepatitis C virus is highly endemic and NHL has high incidence, questions arise about the association of both diseases especially in children.
The primary aim of this study was to describe the epidemiological situation of NHL in children associated with HCV in Mansoura, Egypt.
Pediatric patients provisionally diagnosed as suffering from NHL were recruited from hematology unit at Mansoura University children hospital (MUCH) from January 2013 to March 2014. Hematologists collected demographic characteristics, clinical history, and laboratory and treatment data.
Blood samples were collected from each participant in the study and subjected to complete virological profiles to detect hepatitis C specific IgG, hepatitis B Surface antigen (HBsAg) and anti hepatitis B core IgM (HBcIgM) and HIV specific immunoglobulin G. Sera samples were subjected to real time polymerase chain reaction to determine active infection.
The present study was carried out on 92 children with NHL. They were mainly males (69.9%) with mean age 6.9± 3.7 years. The lymphoma was mainly Burkitt type (54.3%). The patients were mainly in stage 3 (80.5%). HCV IgG was positive in 41.3% of the patients and HCV viremia was detected in 43.5% of the patients, while none of the control subjects had any positive HCV markers.
In comparative study between NHL associated with active HCV and those not associated with active HCV, there was statistically significant elevations of ALT (P=0.002), AST (P=0.03) and bilirubin (P=0.005). History of blood transfusions, though was common among NHL associated with HCV (75%) than those not associated with HCV (42.3%), this was statistically insignificant difference (P=0.13). HCV viremia was associated with 30% of patients with recent incidence of NHL. There was statistically significant association of HCV IgG with HCV viremia (90%-P=0.0001).
The results presented here describe a strong association of chronic HCV infection with NHL. Much remains unknown about the natural history of HCV infection and its possible contribution to carcinogenesis; however, our data suggest that NHL may be among the malignant complications of chronic HCV infection in children. It is strongly recommended to screen all children, in endemic areas for HCV, affected with NHL for HCV IgG and when positive to evaluate them by PCR.
References
Parkin DM, Whelan SL, Ferlay J, et al. Cancer Incidence in Five Continents, Vol. 8. Lyon, France: International Agency for Research on Cancer; 2002.
Freedman LS. Cancer Incidence in Four Member Countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC) Compared with US SEER. National Cancer Institute, Middle East Cancer Consortium. 2006. NIH Pub. No. 06-5873. Bethesda, MD: 150.
Curado MP, Edwards B, Shin HR, et al., editors. Cancer Incidence in Five Continents, Vol. 9. Lyon, France: International Agency for Research on Cancer; 2007. 101.
Soliman AS, Boffetta P. Lymphoma and leukemia. In: Freedman LS, Edwards BK, Ries LAG, Young JL, editors. Cancer Incidence in the Four Member Countries (Cyprus, Egypt, Israel, and Jordan) of the Middle East Cancer Consortium (MECC). Bethesda, MD: National Cancer Institute; 2006. p. 131-140
Hartge P, Wang SS, Bracci PM, et al. Non-Hodgkin's Lymphoma. In: Schottenfeld D, Fraumeni JF, editors. Cancer Epidemiology and Prevention. New York: Oxford University Press; 2009. p. 898-918. DOI: https://doi.org/10.1093/acprof:oso/9780195149616.003.0046
International Agency for Research on Cancer. IARC Monographs on the evaluation of carcinogenic risks to humans, Vol. 67, Human Immunodeficiency Viruses and Human t-cell lymphotropic viruses. Geneva, Switzerland: IARCPress; 1996.
Armstrong BK, Kricker A. Sun exposure and non-Hodgkin lymphoma. Cancer Epidemiol Biomarkers Prev 2007; 16: 96- 400. Published on 20070302. DOI: https://doi.org/10.1158/1055-9965.EPI-06-1068
Boffetta P, de Vocht F. Occupation and the risk of non- Hodgkin lymphoma. Cancer Epidemiol Biomarkers Prev 2007; 16: 369-372. http://dx.doi.org/10.1158/1055-9965.EPI-06-1055 DOI: https://doi.org/10.1158/1055-9965.EPI-06-1055
Linet MS, Schubauer-Berigan MK, Weisenburger DD, et al. Chronic lymphocytic leukemia: an overview of aetiology in light of recent developments in classification and pathogenesis. Br J Haematol 2007; 139: 672-686. http://dx.doi.org/10.1111/j.1365-2141.2007.06847.x DOI: https://doi.org/10.1111/j.1365-2141.2007.06847.x
Larson RA, Le Beau MM. Prognosis and therapy when acute promyelocytic leukemia and other “good risk” acute myeloid leukemias occur as a therapy-related myeloid neoplasm. Mediterr J Hematol Infect Dis 2011; 3: e2011032. Published on 20110708. DOI: https://doi.org/10.4084/mjhid.2011.032
Leone G, Fianchi L, Voso MT. Therapy-related myeloid neoplasms. Curr Opin Oncol 2011; 23: 672-680. http://dx.doi.org/10.1097/CCO.0b013e32834bcc2a DOI: https://doi.org/10.1097/CCO.0b013e32834bcc2a
Bari A, Marcheselli L, Marcheselli R, et al. Therapy-related myeloid neoplasm in non-hodgkin lymphoma survivors. Mediterr J Hematol Infect Dis 2011; 3: e2011065. Published on 20111220. DOI: https://doi.org/10.4084/mjhid.2011.065
Eichenauer DA, Engert A. Therapy-related myeloid neoplasms in patients treated for hodgkin lymphoma. Mediterr J Hematol Infect Dis 2011; 3: e2011046. Published on 20111024. DOI: https://doi.org/10.4084/mjhid.2011.046
Zhou Y, Tang G, Medeiros LJ, et al. Therapy-related myeloid neoplasms following fludarabine, cyclophosphamide, and rituximab (FCR) treatment in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma. Mod Pathol 2011; 25: 237-245. DOI: https://doi.org/10.1038/modpathol.2011.158
Lehman EM, Wilson ML. Epidemiology of hepatitis viruses among hepatocellular carcinoma cases and healthy people in Egypt: a systematic review and meta-analysis. Int J Cancer 2009; 124: 690-697. http://dx.doi.org/10.1002/ijc.23937 DOI: https://doi.org/10.1002/ijc.23937
Viswanatha DS, Dogan A. Hepatitis C virus and lymphoma. J Clin Pathol 2007; 60: 1378-1383. http://dx.doi.org/10.1136/jcp.2007.051870 DOI: https://doi.org/10.1136/jcp.2007.051870
Charles ED, Dustin LB. Hepatitis C virus-induced cryoglobulinemia. Kidney Int 2009; 76: 818-824. Published on 20090715. DOI: https://doi.org/10.1038/ki.2009.247
International Agency for Research on Cancer. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 100, Part B: Biological Agents. Geneva, Switzerland: WHO Press; 2009.
Mazzaro C, Tirelli U, Pozzato G. Hepatitis C virus and non- Hodgkin's lymphoma 10 years later. Dig Liver Dis 2005; 37: 219-226. http://dx.doi.org/10.1016/j.dld.2005.01.003 DOI: https://doi.org/10.1016/j.dld.2005.01.003
Lehman EM, Soliman AS, Ismail K, et al. Patterns of hepatocellular carcinoma incidence in Egypt from a population-based cancer registry. Hepatol Res 2008; 38: 465- 473. Published on 20071127. DOI: https://doi.org/10.1111/j.1872-034X.2007.00299.x
Ferri C, Monti M, La Civita L, et al. Hepatitis C virus infection in non-Hodgkin's B-cell lymphoma complicating mixed cryoglobulinaemia. Eur J Clin Invest 1994; 24: 781-84. http://dx.doi.org/10.1111/j.1365-2362.1994.tb01077.x DOI: https://doi.org/10.1111/j.1365-2362.1994.tb01077.x
Ascoli V, Lo Coco F, Artini M, Levrero M, Martelli M, Negro F. Extranodal lymphomas associated with hepatitis C virus infection. Am J Clin Pathol. 1998; 109(5): 600-9. DOI: https://doi.org/10.1093/ajcp/109.5.600
De Rosa G, Gobbo ML, De Renzo A, et al. High prevalence of hepatitis C virus infection in patients with B-cell lymphoproliferative disorders in Italy. Am J Hematol 1997; 55: 77-82. http://dx.doi.org/10.1002/(SICI)1096- 8652(199706)55:2<77::AID-AJH5>3.0.CO;2-# DOI: https://doi.org/10.1002/(SICI)1096-8652(199706)55:2<77::AID-AJH5>3.0.CO;2-#
De Vita S, Zagonel V, Russo A, et al. Hepatitis C virus, non- Hodgkin's lymphomas and hepatocellular carcinoma. Br J Cancer 1998; 77: 2032-35. http://dx.doi.org/10.1038/bjc.1998.338 DOI: https://doi.org/10.1038/bjc.1998.338
Luppi M, Longo G, Ferrari MG, et al. Clinico-pathological characterization of hepatitis C virus-related B-cell non- Hodgkin's lymphomas without symptomatic cryoglobulinemia. Ann Oncol 1998; 9: 495-98. http://dx.doi.org/10.1023/A:1008255830453
Mazzaro C, Zagonel V, Monfardini S, et al. Hepatitis C virus and non-Hodgkin's lymphomas. Br J Haematol 1996; 94: 544-50. http://dx.doi.org/10.1046/j.1365-2141.1996.6912313.x DOI: https://doi.org/10.1046/j.1365-2141.1996.6912313.x
Pozzato G, Mazzaro C, Crovatto M, et al. Low-grade malignant lymphoma, hepatitis C virus infection, and mixed cryoglobulinemia. Blood 1994; 84: 3047-53. DOI: https://doi.org/10.1182/blood.V84.9.3047.bloodjournal8493047
Silvestri F, Barillari G, Fanin R, et al. Hepatitis C virus infection among cryoglobulinemic and non-cryoglobulinemic B-cell non-Hodgkin's lymphomas. Haematologica 1997; 82: 314-17.
Vallisa D, Berte R, Rocca A, et al. Association between hepatitis C virus and non-Hodgkin's lymphoma, and effects of viral infection on histologic subtype and clinical course. Am J Med 1999; 106: 556-60. http://dx.doi.org/10.1016/S0002-9343(99)00069-8 DOI: https://doi.org/10.1016/S0002-9343(99)00069-8
Zignego AL, Ferri C, Giannini C, et al. Hepatitis C virus infection in mixed cryoglobulinemia and B-cell non-Hodgkin's lymphoma: evidence for a pathogenetic role. Arch Virol 1997; 142: 545-55. http://dx.doi.org/10.1007/s007050050100 DOI: https://doi.org/10.1007/s007050050100
Montella M, Crispo A, Frigeri F, et al. HCV and tumors correlated with immune system: a case-control study in an area of hyperendemicity. Leuk Res 2001; 25: 775-81. http://dx.doi.org/10.1016/S0145-2126(01)00027-3 DOI: https://doi.org/10.1016/S0145-2126(01)00027-3
Kashyap A, Nademanee A, Molina A. Hepatitis C and B-cell lymphoma. Ann Intern Med 1998; 128: 695. http://dx.doi.org/10.7326/0003-4819-128-8-199804150- 00022 DOI: https://doi.org/10.7326/0003-4819-128-8-199804150-00022
El-Sayed GM, Mohamed WS, Nouh MA, Moneer MM, El- Mahallawy HA. Viral genomes and antigen detection of hepatitis B and C viruses in involved lymph nodes of Egyptian non-Hodgkin's lymphoma patients. Egypt J Immunol. 2006; 13(1): 105-14.
Karen D Cowgill, Christopher A Loffredo, Soheir Abdel-Latif Eissa, Nadia Mokhtar, Mohamed Abdel-Hamid, Ahmed Fahmy and G Thomas. Strickl and Case-control study of non- Hodgkin's lymphoma and hepatitis C virus infection in Egypt.Int. J. Epidemiol. 2004; 33 (5): 1034-1039. DOI: https://doi.org/10.1093/ije/dyh183
Luppi M, Longo G, Ferrari MG, et al. Clinico-pathological characterization of hepatitis C virus-related B-cell non- Hodgkin's lymphomas without symptomatic cryoglobulinemia. Ann Oncol 1998; 9: 495-98. http://dx.doi.org/10.1023/A:1008255830453 DOI: https://doi.org/10.1023/A:1008255830453
Silvestri F, Barillari G, Fanin R, et al. Impact of hepatitis C virus infection on clinical features, quality of life and survival of patients with lymphoplasmacytoid lymphoma/ immunocytoma. Ann Oncol 1998; 9: 499-504. http://dx.doi.org/10.1023/A:1008265804550 DOI: https://doi.org/10.1023/A:1008265804550
Silvestri F, Barillari G, Fanin R, et al. Hepatitis C virus infection among cryoglobulinemic and non-cryoglobulinemic B-cell non-Hodgkin’s lymphomas. Haematologica 1997; 82: 314-317.
Mazzaro C, Franzin F, Tulissi P, et al. Regression of monoclonal B-cell expansion in patients affected by mixed cryoglobulinemia responsive to ????-interferon therapy. Cancer 1996; 77: 2604-2613. http://dx.doi.org/10.1002/(SICI)1097- 0142(19960615)77:12<2604::AID-CNCR26>3.0.CO;2-V DOI: https://doi.org/10.1002/(SICI)1097-0142(19960615)77:12<2604::AID-CNCR26>3.0.CO;2-V
Patriarca F, Silvestri F, Fanin R, et al. Long-lasting complete remission of hepatitis C virus (HCV) infection and HCVassociated immunocytoma with ????-interferon treatment. Br J Haematol 2001; 112: 370-372. http://dx.doi.org/10.1046/j.1365-2141.2001.02571.x DOI: https://doi.org/10.1046/j.1365-2141.2001.02571.x
Hermine O, Lefrere F, Bronowicki J-P, et al. Regression of splenic lym-phoma with villous lymphocytes after treatment of hepatitis C virus infection. N Engl J Med 2002; 347: 89-94. http://dx.doi.org/10.1056/NEJMoa013376 DOI: https://doi.org/10.1056/NEJMoa013376