Increased hepatitis C viral load and reactivation of liver disease in HCV RNA-positive patients with onco-haematological disease undergoing chemotherapy

Coppola, Nicola; Pisaturo, M.; Guastafierro, Salvatore; Tonziello, Gilda; Sica, Antonello; Iodice, V.; Sagnelli, Caterina; Ferrara, Maurizio

doi:10.1016/j.dld.2011.07.016

Cited by 76 publications

(52 citation statements)

References 37 publications

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“…As in most previous reports, the ALT levels in this case increased in association with the HCV RNA level following the administration of systemic corticosteroid pulse therapy, and the HCV RNA level decreased gradually as the dose of steroids was tapered. However, the mortality rate is reportedly similar between HBV-and HCVinfected patients with severe hepatitis (15), and several studies have shown that hepatic dysfunction caused by HCV reactivation may lead to frequent modifications and interruptions in therapy for the primary disease, thereby worsening the overall outcome (13,16). Furthermore, the long-term impact of chronic HCV infection can be serious, as cytotoxic and immunosuppressive treatment may accelerate progression to cirrhosis (15).…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, this is the first report of HCV reactivation caused by a single administration of steroid therapy for collagen disease. HCV reactivation is associated with the use of various immunosuppressive and chemotherapeutic agents, including busulfan, cytarabine, cyclosporine, gemcitabine, methotrexate, rituximab and vincristine (5)(6)(7)(11)(12)(13)(14)(15)(16). Many patients who exhibit HCV reactivation during treatment with one of these drugs are simultaneously treated with corticosteroids (11,12).…”

Section: Discussionmentioning

confidence: 99%

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Hepatitis C Virus (HCV) Reactivation Caused by Steroid Therapy for Dermatomyositis

et al. 2014

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A Japanese woman was treated with injectable methylprednisolone and oral prednisolone for dermatomyositis. On admission, her serum was positive for anti-hepatitis C virus (HCV) antibodies, although HCV RNA was undetectable on polymerase chain reaction. Glucocorticoid therapy improved the dermatomyositis; however, the serum alanine aminotransferase levels rapidly increased, with positive serum HCV RNA and a high viral titer. Both parameters decreased in association with prednisolone tapering, whereas dermatomyositis subsequently recurred and the administration of glucocorticoid therapy was repeated. The serum alanine aminotransferase and HCV RNA levels subsequently increased in a similar manner to that observed after the first course of therapy. Liver enzymes and the viral load should be monitored in anti-HCV-positive patients receiving immunosuppressives, even if serum HCV RNA is negative.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hepatitis C Virus (HCV) Reactivation Caused by Steroid Therapy for Dermatomyositis

et al. 2014

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“…61 Among patients with cirrhosis, the risk of lifethreatening reactivation is greater. 62 Nevertheless, this is clearly an area of flux in the era of novel therapies for HCV. There has been a suggestion that patients receiving potent immunosuppressive targeted therapies should be closely monitored for potential development of hepatic flare, 63 but this is controversial in a new era of clinical investigations, and there are no special guidelines for patients with AML.…”

Section: Scenario 5: Patient With Hepatitismentioning

confidence: 99%

How I treat acute myeloid leukemia presenting with preexisting comorbidities

Ofran

Tallman

Rowe

2016

Blood

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Acute myeloid leukemia (AML) is a devastating disease with an incidence that progressively increases with advancing age. Currently, only ∼40% of younger and 10% of older adults are long-term survivors. If untreated, the overall prognosis of AML remains dismal. Initiation of therapy at diagnosis is usually urgent. Barriers to successful therapy for AML are the attendant toxicities directly related to chemotherapy or those associated with inevitable aplasia. Organ dysfunction often further complicates such toxicities and may even be prohibitive. There are few guidelines to manage such patients and the fear of crossing the medico-legal abyss may dominate. Such clinical scenarios provide particular challenges and require experience for optimal management. Herein, we discuss select examples of common pretreatment comorbidities, including cardiomyopathy, ischemic heart disease; chronic renal failure, with and without dialysis; hepatitis and cirrhosis; chronic pulmonary insufficiency; and cerebral vascular disease. These comorbidities usually render patients ineligible for clinical trials and enormous uncertainty regarding management reigns, often to the point of withholding definitive therapy. The scenarios described herein emphasize that with appropriate subspecialty support, many AML patients with comorbidities can undergo therapy with curative intent and achieve successful long-term outcome.

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“…76 Treatment of hepatitis C-related cryoglobulinemia is associated with transiently increased expression of HCV RNA and may be followed by hepatic flare, possibly immune-mediated, which can be life threatening in cirrhotic patients. 77 Direct and indirect roles for B cells have been suggested to explain these observations. Results from in vitro models suggest that HCV is released from B cells in the presence of rituximab and may contribute to the increased viral load observed in patients.…”

Section: Cd20mentioning

confidence: 99%