Chronic Hepatitis C Virus Infection After Treatment for Pediatric Malignancy

Cesaro, Simone; Petris, Maria Grazia; Rossetti, Francesco; Cusinato, Riccardo; Pipan, Corrado; Guido, Maria; Masiero, Lucia; Botta, Giuseppe; Meloni, G. A.; Zanesco, Luigi

doi:10.1182/blood.v90.3.1315.1315_1315_1320

Cited by 22 publications

(12 citation statements)

References 29 publications

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“…These findings are in accord with the natural history of hepatitis C in the first decade after infection in other studies of marrow transplant survivors and survivors of childhood malignancy. 3,53,54 However, we have observed the development of cirrhosis leading to hepatic decompensation and hepatocellular carcinoma in marrow transplant recipients surviving beyond 10 years. 11 Liver biopsy is needed to fully assess the severity of liver disease in all HCV-infected long-term survivors.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C Virus Infection and Bone Marrow Transplantation: A Cohort Study With 10–Year Follow–Up

et al. 1999

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Before the introduction of routine blood donor screening in 1991, marrow transplant recipients were at significant transfusion-associated risk for infection with hepatitis C virus (HCV). We followed a cohort of 355 patients undergoing transplant in Seattle during 1987 to 1988 to determine (1) the impact of pretransplant HCV infection on the occurrence and severity of venocclusive disease (VOD); (2) the impact of HCV infection on liver dysfunction, other than VOD, occurring between 21 and 60 days after transplantation; and (3) the natural history of post-transplant HCV liver disease with a 10-year follow-up. HCV-RNA status was determined on serum stored before transplant and at day 100 post-transplant. Sixty-two (17%) patients were HCV-RNA positive before transplant, and 113 (32%) were HCV-RNA positive by day 100 post-transplant (or before death). Severe VOD developed in 22 of 46 (48%) evaluable patients with pretransplant HCV infection and in 150 of 229 (14%) evaluable patients without HCV (P F .0001). In multivariable analysis of risk factors for developing VOD, pretransplant HCV infection associated with elevated serum aspartate transaminase (AST) levels predicted the development of severe VOD (relative risk, 9.6; P ‫؍‬ .0001). The presence of HCV with normal AST levels before transplant was not a risk factor for severe VOD. Between 21 and 60 days after transplant, HCV-RNA positive-patients had higher AST levels (median 101 U/L), but similar alkaline phosphatase and total bilirubin levels compared with HCV-negative patients, suggesting that cholestatic liver disease (particularly graft-versus-host disease [GVHD]) was not related to HCV infection. An acute flare of hepatitis (AST G10 times the upper limit of normal) developed at a mean of 136 ؎ 58 days in 31% of HCV-positive patients; no patients developed fulminant hepatitis. Between 5 and 10 years after transplant, 57% of HCV-positive and 6% of HCV-negative patients had mild to moderate elevations of AST (P F .0001), but HCV infection was not associated with excess mortality between 3 and 10 years after bone marrow transplantation. In summary, HCV infection with elevated AST levels is a significant risk factor for severe VOD after marrow transplant. However, the decision to proceed to transplantation in HCV-positive patients must balance the absolute risk of death from VOD against the risks of the underlying disease. In long-term survivors, HCV infection is not associated with excess mortality over 10 years of follow-up. (HEPATOLOGY 1999;29:1893-1899.)

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Section: Discussionmentioning

confidence: 99%

Hepatitis C Virus Infection and Bone Marrow Transplantation: A Cohort Study With 10–Year Follow–Up

et al. 1999

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“…The reasons for this observation are not known, but may relate to more vigorous immune responses to an infection acquired early in life, reduced fibrogenic mechanisms in children and/or the confounding effects of alcohol, obesity and co-infections in adult patients (8,53). Although children tend to have more indolent HCV-infection than adults, the development of severe liver diseases can be accelerated in the presence of co-morbid conditions such as thalassemia (9), iron overload (9,21), childhood cancer (7,8,22,23), and HIV co-infection (40).…”

Section: Discussionmentioning

confidence: 99%

“…Hepatitis C virus (HCV) progresses insidiously and incrementally, and results in potentially serious complications such as cirrhosis and hepatocellular carcinoma in approximately 20% and 4 % of adult patients respectively (1)(2)(3)(4). However, data on the natural history and histopathology of HCV-related liver disease in children are conflicting (5)(6)(7)(8)(9)(10)(11)(12)(13). Studies from Japan and Europe point to relatively benign clinical and histopathologic liver disease (14)(15)(16)(17)(18)(19)(20) whereas studies from the USA suggest a more aggressive course with development of early fibrosis (21)(22)(23).…”

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confidence: 99%

Clinical Spectrum and Histopathologic Features of Chronic Hepatitis C Infection in Children

Mohan

Colvin²,

Glymph³

et al. 2007

The Journal of Pediatrics

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“…Once infected the majority of them maintained virus replication and developed chronic hepatitis. Early reports on the clinical features and outcome of hepatitis C in children cured of malignancy, including our own studies [8][9][10] showed a high survival rate, and relatively low levels of ALT, 10-20 years after diagnosis. More recently, Castellino et al investigated liver histology obtained for staging purposes or before therapy in 60 HCV infected patients cured of pediatric malignancy.…”

Section: Introductionmentioning

confidence: 72%

An updated follow‐up of chronic hepatitis C after three decades of observation in pediatric patients cured of malignancy

Cesaro

Bortolotti

Petris

et al. 2010

Pediatric Blood & Cancer

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BackgroundThe aim of the study was to evaluate the clinical characteristics and the long‐term outcome of chronic hepatitis C in a cohort of Caucasian children cured of pediatric malignancy.ProcedureThe study population included 83 consecutive patients, referred to our Center with a diagnosis of leukemia/lymphoma (50) or solid tumors (33) between 1977 and 1989 and infected with hepatitis C virus (HCV) during chemotherapy.ResultsAt enrollment 77 subjects were HCV‐RNA positive. After a median follow‐up of 21 years (range 13–36), a sustained virological response (SVR) was obtained in 3 of 29 patients (10%) treated with interferon (IFN), in 1 of 3 patients (33%) treated with IFN and ribavirin, and in 5 of 11 patients (42%) treated with pegylated‐IFN and ribavirin (P = 0.03). Forty‐two patients remained untreated and only one (2.5%) cleared viremia. Four of 77 patients (5%) developed cirrhosis while other 4 patients died of causes not related to liver. At last follow‐up, 72% of HCV‐RNA positive patients had abnormal ALT.ConclusionsIn patients cured of pediatric malignancy chronic hepatitis C tends to run an indolent course during childhood and adolescence but more than 70% of treated and more than 80% of untreated cases children maintained HCV viremia. Moreover, after 2–3 decades of observation, 60% of HCV‐RNA positive patients had abnormal ALT and 5% had developed cirrhosis. Among treated patients, IFN or pegylated‐IFN and ribavirin obtained the higher rate of HCV‐RNA clearance. Pediatr Blood Cancer 2010;55:108–112. © 2010 Wiley‐Liss, Inc.

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Chronic Hepatitis C Virus Infection After Treatment for Pediatric Malignancy

Cited by 22 publications

References 29 publications

Hepatitis C Virus Infection and Bone Marrow Transplantation: A Cohort Study With 10–Year Follow–Up

Hepatitis C Virus Infection and Bone Marrow Transplantation: A Cohort Study With 10–Year Follow–Up

Clinical Spectrum and Histopathologic Features of Chronic Hepatitis C Infection in Children

An updated follow‐up of chronic hepatitis C after three decades of observation in pediatric patients cured of malignancy

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