Non Hodgkin Lymphoma and Hepatitis C Virus in Egyptian Children: One Centre Study

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.