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However, the strategy of antiviral therapy after completion of chemotherapy in the HCV-positive patient is attractive and was associated with improved outcomes in one small retrospective study. 11 The optimal timing of HCV antiviral therapy in aggressive lymphoma will require prospective study, and the results from Ennishi et al suggest that further efforts to prevent progressive liver failure after treatment are needed (see figure). The greatest advance in the treatment of DLBCL in the past 2 decades has been the addition of rituximab to CHOP (or CHOP-like) chemotherapy, which has increased survival rates significantly in all subgroups with the disease. 12 Patients with DLBCL and HCV infection appear to derive similar benefits. Whether R-CHOP has an adverse effect on the long-term natural history of HCV infection and its complications similar to that reported after allogeneic hematopoietic cell transplanta-tion is unclear. 13 It is clear that care must be used to monitor for acute and chronic hepato-toxicity associated with therapy, particularly in those with elevated transaminases at presentation or with underlying hepatic complications of HCV infection (including HCC). The role of antiviral therapy in aggressive lym-phoma remains undefined and will require focused study. Conflict-of-interest disclosure: The author declares no competing financial interests. ■ REFERENCES 1. Ennishi D, Maeda Y, Niitsu N, et al. Hepatic toxicity and prognosis in HCV-infected patients with diffuse large B-cell lymphoma treated with rituximab-containing che-motherapy regimens: a Japanese multicenter analysis. Risk of non-Hodgkin lymphoma and lymphoproliferative precursor diseases in US veterans with hepatitis C virus. JAMA. Hepatitis C virus and risk of non-Hodgkin lymphoma: a population-based case-control study among Connecticut women. and outcome of diffuse large B-cell lymphoma in hepatitis C virus-positive patients in LNH 93 and LNH 98 Groupe d'Etude des Lymphomes de l'Adulte programs. natural history in hepatitis C virus positive diffuse large B-cell lymphoma: analysis of 156 patients from northern Italy. virus and alanine amino-transferase kinetics following B-lymphocyte depletion with rituximab: evidence for a significant role of humoral immunity in the control of viremia in chronic HCV liver disease. of splenic lymphoma with villous lymphocytes after treatment of hepatitis C virus infection. Prospective analysis of hepatitis B virus reactivation in patients with diffuse large B-cell lymphoma after rituximab combination chemotherapy. [Published online ahead of print September 13, 2010]. J Clin Oncol. therapy after complete response to chemotherapy could be efficacious in HCV-positive non-Hodgkin's lymphoma.duction of combined CHOP plus rituximab therapy dramatically improved outcome of …