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Algorithm for Managing Patient with HCV-Related Cryoglobulinemia

Purpose: To manage a patient with HCV-related cryoglobulinemia based on the algorithm of Dammacco and Sansonno.

Description

Dammacco and Sansonno proposed a management algorithm for patients with HCV-related cryoglobulinemia. The authors are from the University of Bari in Italy.


Patient selection: patient with cryoglobulinemia secondary to HCV

 

Parameters:

(1) clinical status cryoglobulinemic vasculitis

(2) malignant lymphoma

 

Clinical Status

Management

asymptomatic

monitor with or without antiviral therapy

cutaneous findings only (no organ damage)

antiviral therapy with or without corticosteroids

organ damage

antiviral therapy AND corticosteroids AND B-cell depleting monoclonal antibody

rapidly progressive or life-threatening

plasmapheresis AND corticosteroids AND B-cell depleting monoclonal antibody with or without cyclophosphamide, followed by antiviral therapy

 

where:

• B-cell depleting monoclonal antibodies are rituximab or ofatumumab

• Low to moderate doses of corticosteroids can help to reduce symptoms.

• Cyclophosphamide can be helpful in life-threatening cases but increases the risk of infection.

 

If the patient develops a non-Hodgkin’s B-cell lymphoma then therapy consists of:

(1) antiviral therapy

(2) rituximab

(3) addition of chemotherapy if lymphoma recurrent or resistant


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Specialty

Objective

ICD-10