HepC and NHL(Non Hodgkins Lymphoma)

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. He was however UND at 12 wks & remained UND at his 3mth PCR test, so contrary to what his gastro says, I believe he DID tolerate tx OK.
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.

The lymph nodes in his neck have flared twice since diagnosis. He has been referred to a radiation oncologist who will treat if it flares again. However, I understand it is best to not treat this indolent form unless absolutely necessary. He is also to have a test for cryoglobulins, which would be another diagnostic tool to link the MZL with HepC.

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

  

[PaulMD]

Hi there.

The present situation of thrombocytopenia in a background of a cirrhotic liver can really discourage doctors for further treatment of the Hepatitis C, as treatment would cause further drop in the levels of the platelets.  

The cause of the thrombocytopenia should be investigated, and in his situation, it is most likely from the cirrhosis itself, or there may be a bone marrow infiltration from the marginal zone lymphoma (which can be verified through a bone marrow examination).  If there is indeed bone marrow involvement, then treatment for the MZL may be warranted.  If the platelets improve, then you might encounter less resistance regarding restarting treatment for the Hepatitis C.

[Dek07]

Thank you for your response

Are there any drugs available to help boost platelet count? I have heard of them but wonder if they are commonly used?

I know of others who are on interferon based therapy with cirrhosis & thrombocytopenia but it is not optimal to reduce the dosage, since success rate is lowered.  
Since the MZL is infection driven (most likely a result of chronic HepC infection for 30+ years), the obvious treatment is to re- treat the HepC.
This can put the MZL into remission, even if the HepC is not cleared.

Cheers
Dek