A few years ago the Healing a patient with multiple myeloma After being treated for hepatitis C, he surprised the researchers in the group Joaquin Martinezfrom the Hematological Tumors Clinical Research Unit, a collaboration of the 12 de Octubre Hospital (H12O) and the National Cancer Research Center (CNIO).
Multiple myeloma is one of the most common types of blood cancer. Therefore, the desire to understand this healing has led to the discovery that Hepatitis B and C viruses are one of the causesand that eliminating the infection with antiviral drugs is the way to combat many cases of this serious disease.
The discovery, made in collaboration with Sylvie Hermouetfrom the University of Nantes, recently earned an editorial in the journal hematology. “Recognition of this association between viral hepatitis and multiple myeloma, as well as the pathologies that precede the onset of myeloma (monoclonal gammopathies), has important clinical implications,” the article states.
And he adds: “Early detection of hepatitis B or C virus infection in these individuals may lead to appropriate antiviral treatment and subsequent improvement in outcomes.”
It is not known what causes multiple myeloma, and although it has long been suspected that it is related to infectious pathogens, this link has never been proven or the cause understood.
María Linares and Alba Rodríguez-García, researchers at H12O-CNIO and the Complutense University of Madrid (UCM), decided to investigate the surprising recovery of the hepatitis patient. To do this, they resorted to the theory that attributes the cause of multiple myeloma to the body's chronic exposure to an infectious agent.
An excess of antibodies is stopped by antivirals
Multiple myeloma involves an overgrowth of blood cells that produce antibodies (also called immunoglobulins), proteins that protect the body from infections. In myeloma, a specific antibody – different depending on the infectious agent – is produced continuously and excessively.
One theory is that this abnormality is due to chronic exposure to the infectious agent, which alters the biochemical signals involved in the production of the specific antibody.
The healing of the patient with myeloma and hepatitis C after treatment of this infectious disease seems to support this theory. Linares and Rodríguez-García suspected that the body was no longer chronically exposed to the hepatitis virus because the antiviral drug eliminated it, and that is why the myeloma disappeared – the cells that produce anti-hepatitis C antibodies stopped to multiply excessively.
To investigate whether this was actually the case, two studies were carried out in which 54 patients with monoclonal gammopathy (the pathology that precedes multiple myeloma) and hepatitis were included: 9 patients with hepatitis C in a first study and 45 patients with hepatitis B, in the work published in hematology.
Most of them discovered that the antibody they were constantly and excessively producing was actually against the hepatitis virus.
They then analyzed a much larger cohort of multiple myeloma patients (more than 1,300) infected with hepatitis B and hepatitis C (more than 1,200). In both cohorts, they concluded that those who received antiviral treatment had “a significantly higher likelihood of survival.”
New options for early detection and treatment
The authors assure that “in patients infected with the hepatitis B or hepatitis C virus, multiple myeloma or gammopathy can be caused by these viruses and the study shows the importance of antiviral treatment in these patients.”
Chronic hepatitis B or hepatitis C virus infections contribute to the pathogenesis of these hematologic malignancies and warrant increased awareness, detection, and treatment strategies.
The journal's editorial states: “The association between viral hepatitis and the development of multiple myeloma and other monoclonal gammopathies has become an important area of research.” “Chronic infections caused by the hepatitis B or hepatitis C virus contribute to the pathogenesis of these hematologic diseases malignancies, warranting an increase in awareness, detection and treatment strategies.”
“In patients with gammopathies caused by this hepatitis – which can be identified by analyzing the antibodies they produce in excess – “antiviral therapy should be prescribed as soon as possible,” he concludes.
Reference:
Rodríguez-García A. et al.: “Short-chain fatty acid production by the gut microbiota predicts treatment response in multiple myeloma.” Clin Cancer Res. (2023).
This work was financed with funds from the Ligue Nationale contre le Cancer (Comités Départementaux 44, 56, 29, 85, 35) and the Spanish Society of Hematology. The authors thank the Hospital 12 de Octubre Research Institute (i+12), the CIBERONC, the AECC (Accelerator and Ideas Semilla Award) and the CRIS Foundation for their help.
