HepC and NHL(Non Hodgkins Lymphoma)

[Dek07]

Hi, I'm new to this site

I would appreciate any information about marginal zone lymphoma (MZL) secondary to HepC infection?
My partner was diagnosed with MZL in Jan 08 by surgical biopsy of a lymph node in his neck. It's a rare indolent form & most likely results from HepC infection. He has a small patch in the bone but CT scans & a PET scan revealed no other nodes in between, so is sort of stage 1 & 4 at the same time.
He is 56yrs old, geno 1b, +ive for over 30 yrs.
The obvious tx is to treat the HepC, which his haematologist agrees with, but unfortunately he relapsed 6mths after 12mths tx on Pegasys in 2005. He has F4 cirrhosis, confirmed by biopsy pre-tx. His main issue with tx was thrombocytopenia which led his Gastro to dose reduce both interferon & ribavirin.
Towards the completion of his tx, his AFP suddenly spiked to 90 & a CT scan revealed a small hepatoma, which was successfully removed by a liver resection in June 2006. He has had no further tumours & his AFP now sits at around 15. The only other remarkable blood issue at the moment is thrombocytopenia (stable at about 85). He has splenomegaly.

He will see his gastro later this month. We are desperately looking for a chance at re-treatment for the HepC, but anticipating some resistance. Even a maintenance type trial which would reduce viral load would be beneficial, since his Haem thinks the lymphoma may be triggered by an increase in viral load, which of course fluctuates.
I would greatly appreciate any info or suggestions regarding my partner’s situation.

Cheers
Dek07

  

[Douglas Dieterich, MD]

Low platelets should not stop therapy in general and in particular in this case where the stakes are so high. I would re treat now after endoscopy to make sure there are no varices. I dont worry so much about platelets usually they are there, but hiding in the spleen so that they come out when you need them. I would recommend retreating for 72 weeks and no lowering of doses! Starting the ribavirin early may help with the platelets and we have been doing that for some people as well. Wish your partner luck! DTD

[Douglas Dieterich, MD]

yes there are drugs available and under study to raise platelet counts. Ribavirin raises platelets a little. In general if you dont have hemophilia or any other bleeding disorder then platelets down to the 20's are likely to be OK. I really try hard not to dose reduce. DTD

[Emilio44]

Hugs and best wishes from a fellow antipodean - Go the Knights.  Dr D and others should be along shortly and may be able to provide you with some advice. Stay strong oo Emi

[Dek07]

I was wondering what definitive tests could be carried out to link marginal zone lymphoma with HepC as the causative infection. My partner's cryo test came back -ive.
His gasto & haematologist are not communicating with each other so he will see a Physician this week who will hopefully be able to give him a more holistic approach.

[BronxRican]

Whats this about pain in the neck? I finished tx in July 06, underwent gallbladder surgery in March 07 but have been feeling ok since. I've gained a LOT of weight since tx. I'm 5'8" and 270lbs.I haven't been back to see my gastro since Feb 07.  I'm a little scareed by the above post about lymphoma. I had no idea you can get that from HEP C. Lately I feel some pain on the left side of my throat...what do you think?\\\

Bronxrican

[Dek07]

I have heard about a lead in tx with ribavirin for relapsers. How does this assist with platelet count?

I just wondered how you would manage thrombocytopenia throughout tx over an extended period without dose reduction of interferon which I realise is not optimum for success & best to avoid.
Are there drugs available to assist with boosting platelet count?

Dek07

[Dek07]

Thank you for your response Dr.

Much appreciated.

Dek07

[Dek07]

I would greatly appreciate some information

Thank you

Dek07