HCV Infection in Very-Long-Term Survivors After Cancer Chemotherapy and Bone Marrow Transplantation

Abstract

The long-term evolution of hepatitis C virus (HCV) infection in oncologic and/or transplanted patients is still unknown. Patients treated for cancer are different from the general HCV-infected population because of the immunosuppression and the hepatotoxic treatments, which act as co-factors of liver damage. Recently it was observed that antimetabolites play a role in accelerating the process of hepatic fibrosis. The aims of this retrospective study were to describe the clinical course of chronic hepatitis C acquired during anticancer treatment in a group of patients referred to a single center, and to correlate the course of hepatic disease to the type of treatment they received. Among the 17 children who underwent very long follow-up (range 10-18.5 years), the authors identified a group with more active hepatic cytolysis through the serial observation of mean ALT values, HCV RNA determination, and histologic data when available. During follow-up, none of them developed hepatic failure, cirrhosis, or hepatocarcinoma. No single risk factor, such as exposure to antimetabolites, alkylating agents, or other chemotherapy, radiotherapy to the abdomen, exposure to other hepatotoxic drugs, appearance of vaso-occlusive disease, acute and/or chronic graft-versus-host disease, or length of immunosuppression, correlated with a worse course of hepatitis. No definitive conclusions can be drawn. However, multivariate analysis of hepatic risk factors in larger cohorts of patients will be able to provide us with more precise information about the clinical outcome of chronic hepatitis in survivors.

Natural course of HCV infection in childhood cancer survivors

“…We found a satisfactory agreement between our definition of cytolytic course and the findings at biopsy (p= 0.031) as in our previous study [26]. Is has been already described that persons who have persistently normal ALT values generally have less severe liver disease than the one observed in those with abnormal aminotransferase level [32,33].…”

“…Hepatic cytolysis was arbitrarily defined, as previously reported, according to serial ALT evaluation [26]. On this basis, the majority (87%) of patients was found to have had a MCC with median annual ALT values within the normal range in more than 50% of the evaluations.…”

“…Moreover, the behavior of hepatic cytolysis was defined as "remarkable" or "moderate" considering the frequency of the observation of yearly median ALT values two times above normal. In more detail, and as previously described [26], patients were defined as having a "remarkable cytolytic course" (RCC) in case that their yearly median ALT values were twice above the normal in more than 50% of the years of follow-up; otherwise, they were considered as having a "moderate hepatic cytolytic course" (MCC).…”

Rare viral infections in children receiving hemopoietic stem cell transplant

“…47 Moreover, a recent survey on 17 children who underwent very long follow-up (range 10-18.5 years) did not show the development of hepatic failure, cirrhosis or hepatocarcinoma, even in the presence of active hepatic cytolysis through the follow-up. 48 Finally, as regards infections due to 'other' hepatitis viruses, no data are available on HAV acute hepatitis after HSCT, while infection with HGV has been reported in HSCT recipients. [49][50][51] The data available in the pediatric population do not support any pathogenic role after either chemotherapy 52 or HSCT.…”

Treating Children With Chronic Hepatitis C After Malignancy in a Single Center

“…Moreover, hepatitis C is symptomatic in 10% of cases; the acute illness is generally asymptomatic and 70-80% of patients develop chronic infection [1,2]. HCV could make the outcome of successfully treated pediatric oncology patients worse, because they receive a hepatotoxic drug during therapy [1, 3, 4].…”