Treating hepatitis may improve patient outcomes in myeloma

Immune response against hepatitis-causing viruses may lead to cancer: Study

Marisa Wexler, MS avatar

by Marisa Wexler, MS |

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A dysregulated immune response against viruses that cause hepatitis may lead to some cases of multiple myeloma (MM) — and in these cases, treating the viral infection may improve the patient’s odds of survival.

That’s according to a new study titled “Impact of viral hepatitis therapy in multiple myeloma and other monoclonal gammopathies linked to hepatitis B or C viruses,” which was published in Haematologica, a journal of the nonprofit Ferrata-Storti Foundation.

“This study demonstrates the importance of antiviral treatments for patients with [hepatitis]-driven clonal gammopathies, including MM,” its researchers wrote, adding that “anti-viral therapy should be prescribed as early as possible.”

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Evidence suggests MM may be partly driven by chronic infections

Myeloma is caused by the excessive growth of plasma cells, which are the immune cells responsible for making antibodies. Multiple myeloma is a monoclonal gammopathy, meaning that all of the cancerous cells are producing the exact same antibody.

There is building evidence that, in some cases, multiple myeloma, or MM, may be driven in part by chronic infections. The basic idea is that plasma cells in the body keep detecting a threat from the chronic infection, which spurs the cells to continue growing.

There are several chronic infections that can affect the liver, leading to liver inflammation or hepatitis. The most common are hepatitis B virus (HBV) and hepatitis C virus (HCV).

Recently, a few studies have shown that, in some people with MM who have chronic HCV infections, the cancer cells make antibodies targeting the hepatitis C virus. The early data suggest that treating the HCV infection may improve outcomes from myeloma in these patients.

Given that, a team of scientists from Spain and France sought to test whether HBV might also be a cause of myeloma in some people with MM.

First, the researchers took cell samples from 45 people with MM or other monoclonal gammopathies who had chronic HBV infections. Using these cells, the researchers conducted a series of tests aiming to identify the exact target of the antibodies made by each patient’s cancer cells.

The team was able to identify the target for 14 of the MM patients — and in half of these cases, the cancer cells were targeting the HBV virus. HBV also was found to be a target in several people with monoclonal gammopathies of undetermined significance, known as MGUS, which refers to patients with myeloma-like plasma cell growth that has not progressed to overt cancer.

This result “implies that HBV initiated the [cancer-like growth of plasma cells] in these individuals,” the researchers wrote.

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New ideas on the potential of treating hepatitis in MM patients

Next, the researchers used a commercial database to identify data from 1,367 MM patients who had chronic HBV infections. Among them, 175 received antiviral treatment for the hepatitis B virus. Statistical tests showed that a significantly higher percentage of patients given antiviral therapy were still alive after three years (77.91% vs. 68.41%).

Using the same database, the scientists also conducted a similar analysis in 1,220 MM patients with chronic HCV infections, of whom 179 received antiviral therapy. Similar to the HBV results and in line with prior studies on hepatitis C virus in MM, these results showed significantly higher three-year survival rates among patients given antiviral treatment (80.46% vs. 70.78%).

There is a need for increased awareness and screening for viral hepatitis in patients with MM and monoclonal gammopathies. Early identification of viral hepatitis in these individuals can lead to appropriate antiviral therapy and subsequent improvement in outcomes.

While these data don’t conclusively prove that treating hepatitis will benefit people with myeloma, the findings support the idea that addressing the infection may improve outcomes at least in some patients, especially in parts of the world where HBV is common.

If it’s true that hepatitis viruses are driving the abnormal growth of B-cells in some patients, then it also follows logically that eliminating the infection at early stages might prevent cancer from developing in the first place.

“Not only would antiviral therapy improve outcomes and the morbidity associated with viral hepatitis, but it could also potentially mitigate the monoclonal gammopathy and the risk of progressing to symptomatic disease,” Elizabeth O’Donnell, MD, a myeloma specialist at the Dana-Farber Cancer Institute, in Boston, wrote in an editorial published alongside the study.

O’Donnell argued that these findings support screening for HBV and HCV in people with myeloma, as well as in individuals with MGUS or other signs of myeloma-like disease.

“There is a need for increased awareness and screening for viral hepatitis in patients with MM and monoclonal gammopathies. Early identification of viral hepatitis in these individuals can lead to appropriate antiviral therapy and subsequent improvement in outcomes,” O’Donnell wrote.