Allogeneic hematopoietic cell transplant in HCV-infected patients

Latour, Régis Peffault de; Ribaud, Patricia; Robin, Marie; Valla, Dominique; Marcellin, Patrick; Socié, Gèrard; Asselah, Tarik

doi:10.1016/j.jhep.2008.03.003

Cited by 36 publications

(33 citation statements)

References 94 publications

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“…All the anti-HCVpositive patients had a compelling indication for transplantation, without any effective therapeutic alternatives. Our recommendations at this point are the same as those that have been proposed by other authors, 30,32 namely to exclude advanced fibrosis or cirrhosis, to follow the patient closely for the development of chronic hepatitis after allogeneic HSCT and to consider antiviral therapy in long-term follow-up, apart from paying careful attention to the early post-transplant course. Along these lines, prevention of hepatitic flares in the immediate post-transplant period through the administration of specific antiviral agents, similar to what can already be done for hepatitis B, may become an important goal in the near future.…”

Section: Discussionmentioning

confidence: 87%

Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies

Ramos¹,

Saliba²,

Padua³

et al. 2009

Haematologica

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BackgroundBecause hepatitis C virus infection causes hepatic and immunological dysfunction, we hypothesized that seropositivity for this virus could be associated with increased nonrelapse mortality after allogeneic hematopoietic stem cell transplantation. Design and MethodsWe performed a case-control study of the outcomes of patients who were hepatitis C virus seropositive at the time of allogeneic hematopoietic stem cell transplantation (N=31). Patients positive for hepatitis C virus were considered candidates for stem cell transplantation only if they had no significant evidence of hepatic dysfunction. Matched controls (N=31) were seronegative for viral hepatitides and were paired according to age, diagnosis, disease stage, conditioning regimen and donor type. We also compared the hepatitis C virus seropositive patients to all seronegative patients (all controls, N=1800) transplanted during the same period, to adjust for other confounding effects. ResultsThe median age of the seropositive patients was 49 (range 26-72); 15 had acute myeloid leukemia/myelodysplastic syndrome, 6 had chronic myeloid leukemia/myeloproliferative disease, 6 non-Hodgkin's lymphoma, 2 myeloma, 1 acute lymphocytic leukemia and 1 Hodgkin's lymphoma; 61% had poor risk disease; 68% had related donors; 68% received reduced intensity conditioning; 7 patients had mildly abnormal alanine transaminase levels (all less than three times the upper limit of normal) and 1 patient had minimally elevated bilirubin. These characteristics were similar to those of the matched control group. Median overall survival was 3, 18 and 20 months, and 1-year survival was 29%, 56% and 56%, in the hepatitis C virus, matched and all controls groups, respectively (hazard ratio for death 3.1, 95% confidence interval 1.9 -5.6, p<0.001 in multivariate analysis). Non-relapse mortality at 1 year was 43%, 24% and 23%, respectively (hazard ratio 3.3, 95% confidence interval 1.8 -7.1, p<0.01). Disease progression and graft-versus-host disease rates were comparable. ConclusionsHepatitis C virus seropositivity is a significant risk factor for non-relapse mortality after allogeneic hematopoietic stem cell transplantation even in patients with normal or minimally abnormal liver function tests.Key words: hematopoietic stem cell transplantation, hepatitis C virus, transplant-related mortality.Citation: Ramos CA, Saliba RM, de Pádua L, Khorshid O, Shpall EJ, Giralt S, Patah PA, Hosing CM, Popat UR, Rondon G, Khouri IF, Nieto YL, Champlin RE, and de Lima M. Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies. Haematologica 2009; 94:249-257. doi:10.3324/haematol.13756 ©2009 Ferrata Storti Foundation. This is an open-access paper. Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies

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Section: Discussionmentioning

confidence: 87%

Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies

Ramos¹,

Saliba²,

Padua³

et al. 2009

Haematologica

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“…patients with immune depression, transplantation, or HIV coThe chance of achieving an SVR significantly decreases in infection [146]. Genetic the IL-10 promoter at positions À819 and À592 have been associated with different IL-10 levels.…”

Section: Response (Svr) Defined As Undetectable Hcv Rna In Serummentioning

confidence: 99%

Genomics and HCV infection: Progression of fibrosis and treatment response

Estrabaud

Vidaud

Marcellin

et al. 2012

Journal of Hepatology

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HCV infection is a global health problem that affects 170 million people worldwide. The severity of the disease varies from asymptomatic chronic infection to cirrhosis and hepatocellular carcinoma (HCC). Recently, the standard of care for genotype 1 patients has greatly improved with the addition of protease inhibitors (telaprevir or boceprevir) to pegylated interferon (PegIFN) and ribavirin (RBV). The prediction of fibrosis progression and the response to antiviral treatment are two major issues in the management of patients with chronic hepatitis C. Differential expression of mRNAs was first analyzed for both progression of fibrosis and treatment response. Specific polymorphisms, associated with either fibrosis or viral response, were identified thanks to major improvements in genome scanning technologies. Since 2009, several independent genome wide association studies (GWAS) have reported an association between genetic polymorphisms within the IL-28B promoter and both natural and treatment-induced clearance in genotype 1 infected patients. These different studies showed the strong association and the importance of IL-28B polymorphisms in the treatment response. Combining the different genetic factors could improve their predictive value and help identify patients at a high risk of progression of fibrosis as well as those with a lower chance of responding to treatment. The aim of this review was to discuss the genomic factors (mRNAs, miRNAs, and SNPs) and HCV infection with clinical implications for either progression of fibrosis or treatment response. Recent findings on the IL-28B polymorphism and its application in clinical practice will also be discussed.

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“…4,6,11,12 After three months, the occurrence of late viral hepatitis is possible, which coincides with a decrease in or discontinuation of immunosuppressive therapy and a return of cellular immunity. 2,3 The most difficult situation at this time is the unusual presentation of liver GVHD (hepatic variant), resembling viral hepatitis, 7,13 in which liver biopsy is essential to confirm GVHD.…”

Section: Short-term Outcomementioning

confidence: 99%

“…Among long-term survivors, cirrhosis is an important late complication of HCT. 2,3 The hepatitis C virus (HCV), identified in 1989, is an enveloped RNA-virus with a 9.6kb single strand genome. A significant proportion of long-term HCVinfected HCT survivors, primarily contaminated through blood exposure, develop cirrhosis and hepatocellular carcinoma during the long-term follow-up.…”

mentioning

confidence: 99%