Impact of viral hepatitis therapy in multiple myeloma and other monoclonal gammopathies linked to hepatitis B or C viruses

Haematologica. 2024 Jan 1;109(1):272-282. doi: 10.3324/haematol.2023.283096.


Subsets of multiple myeloma (MM) and monoclonal gammopathies of undetermined significance (MGUS) present with a monoclonal immunoglobulin specific for hepatitis C virus (HCV), thus are presumably HCV-driven, and antiviral treatment can lead to the disappearance of antigen stimulation and improved control of clonal plasma cells. Here we studied the role of hepatitis B virus (HBV) in the pathogenesis of MGUS and MM in 45 HBV-infected patients with monoclonal gammopathy. We analyzed the specificity of recognition of the monoclonal immunoglobulin of these patients and validated the efficacy of antiviral treatment (AVT). For 18 of 45 (40%) HBV-infected patients, the target of the monoclonal immunoglobulin was identified: the most frequent target was HBV (n=11), followed by other infectious pathogens (n=6) and glucosylsphingosine (n=1). Two patients whose monoclonal immunoglobulin targeted HBV (HBx and HBcAg), implying that their gammopathy was HBV-driven, received AVT and the gammopathy did not progress. AVT efficacy was then investigated in a large cohort of HBV-infected MM patients (n=1367) who received or did not receive anti-HBV treatments and compared to a cohort of HCV-infected MM patients (n=1220). AVT significantly improved patient probability of overall survival (P=0.016 for the HBV-positive cohort, P=0.005 for the HCV-positive cohort). Altogether, MGUS and MM disease can be HBV- or HCV-driven in infected patients, and the study demonstrates the importance of AVT in such patients.

MeSH terms

  • Antiviral Agents / therapeutic use
  • Hepatitis B virus / physiology
  • Hepatitis B* / complications
  • Hepatitis B* / drug therapy
  • Hepatitis C* / complications
  • Hepatitis C* / drug therapy
  • Humans
  • Monoclonal Gammopathy of Undetermined Significance* / drug therapy
  • Monoclonal Gammopathy of Undetermined Significance* / etiology
  • Multiple Myeloma* / complications
  • Multiple Myeloma* / drug therapy


  • Antiviral Agents

Grants and funding

Funding: This work was supported by grants from the Ligue Nationale contre le Cancer (Comités Départementaux 44, 56, 29, 85, 35) (to SH), and a grant from the Spanish Society of Hematology (to ARG). We thank the Instituto de Investigación Hospital 12 de Octubre (i+12), CIBERONC, AECC (Accelerator Award and Ideas Semilla), and the CRIS foundation for their help.