Incidence and morbidity of infection by hepatitis C virus in children with acute lymphoblastic leukaemia

Abstract

A group of 90 patients with acute lymphoblastic leukaemia (ALL) in first continuous complete remission (CCR), admitted in our hospital between January 1986 and September 1992, were tested for the presence of antibodies against hepatitis C virus (HCV), antibodies against hepatitis B virus and antibodies against HIV-1 during maintenance therapy or thereafter. They were compared with a group of 71 children with other malignancies in first CCR who had been diagnosed consecutively from January 1986 to September 1992. No patient with ALL or any other malignancy was found to be positive for hepatitis B surface antigen or HIV-1. HCV-specific antibodies were detected in 28 out of 87 children (32.1%) with ALL and in 4 out of 44 patients (9%) with malignancies other than ALL who had received at least one transfusion of blood or platelets (P < 0.01). HCV-specific antibodies were also detected in one out of three untransfused children with ALL but in none of the untransfused children with malignancies other than ALL. HCV-specific seropositivity influenced the management of children with ALL during maintenance therapy. In fact, as a result of abnormal liver function tests, maintenance therapy had to be suspended significantly more often in the case of HCV-seropositive patients with ALL than in HCV-seronegative ones. Despite the high morbidity during maintenance therapy, chronic liver disease (CLD) was uncommon in both groups: five children with ALL (17.2% of HCV-seropositive children) and one child with a malignancy other than ALL (25%) had CLD.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased risk of chronic hepatitis in children with cancer

“…The incidence of HBsAg positivity in children with cancer reported by various studies [2,3,[17][18][19] ranges from 0 to 56%. Routine hepatitis B vaccination has played a major role in limiting the infection in the last years [20].…”

Interferon treatment of chronic active hepatitis C during therapy of acute lymphoblastic leukemia

“…Those with antibody to HCV had more frequent elevation of ALT and TB and had more frequent interruption of maintenance ALL therapy (82% versus <2%) compared with the ALL patients who were HCV antibody negative. Five of the 28 patients with HCV antibody developed signs of chronic liver disease [7]. The frequency of HCV infection among these children from southern Italy is similar to the 43% reported among 102 children with ALL from northern Italy [6].…”

“…Dibenedetto et al described an 80% frequency of suspension of ALL maintenance therapy in the 29 patients who were HCV antibody positive, but only a 2% frequency of suspensions in those who were HCV antibody negative [7]. Thus, for these patients ALL therapy dose intensity was decreased when hepatitis C infection was present.…”

“…Individuals with acute lymphoblastic leukemia (ALL) are at risk for HCV infection since they usually receive at least one, and typically multiple, transfusions of blood products during the course of their disease [3]. The frequency of antibody to HCV in children with leukemia ranges from 1 to 43% [4][5][6][7]. Reports of interferon treatment of chronic active viral hepatitis have stressed the importance of waiting as long as two years after the completion of antineoplastic therapy to ensure immune competence [8,9].…”

Hepatitis B and C virus infection in Polish children with malignancies

“…Up to 90% of children admitted to hospital for malignancy become infected [8], most of them chronically [1,3] and develop severe chronic liver disease during remission [2,4,5,9,10]. The relative prevalence of hepatitis B virus (HBV) infection has decreased by passive and/or passive-active prophylaxis of HBV infection [8].…”