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

Abstract

Due to concerns that antineoplastic therapy produces prolonged decrease in immune function, interferon treatment of chronic active hepatitis C (CAHC) has been used only at one year or longer after the end of cancer therapy. We report the experience of an 11-year-old who developed symptomatic CAHC at the start of maintenance therapy for testicular relapse of acute lymphoblastic leukemia (ALL). Significant dose reduction of maintenance therapy did not improve the tolerance of antileukemic treatment. In an effort to improve his liver disease and to deliver effective antileukemic therapy, interferon alpha and an alternative maintenance therapy regimen for ALL were initiated. The patient tolerated the combined therapy well. Interferon therapy was continued for 27 months, which was three months from the end of antineoplastic therapy. At that time serum transaminase values were normal, and no HCV viral genome was detectable. Viral genome was detected 10 months later. The combined effects of interferon and antineoplastic therapy resulted in myelosuppression requiring dose reduction of both treatments. The patient remains asymptomatic and with no evidence of recurrent leukemia more than six years from diagnosis of relapse. The effect on the status of this patient's CAHC was similar to that reported among leukemic patients who underwent an interferon course more than one year from the end of antineoplastic therapy. Interferon treatment of CAHC can be given concomitantly with antineoplastic therapy.

Outcome of combination antiviral therapy in chronic hepatitis C virus infection during therapy of acute lymphoblastic leukemia

“…In another report, Waldron described the use of interferon a alone in a patient with chronic HCV hepatitis during therapy of acute lymphoblastic leukemia. [14] The patient required modification of maintenance anti-leukemic treatment. Interferon therapy was continued for 27 months.…”

An Analysis of Published Trials of Interferon Monotherapy in Children With Chronic Hepatitis C

“…Two trials were excluded because they included children infected with hepatitis B virus who could not be eliminated from the mean outcome data (28,29). Two more trials were excluded because IFN-␣ was administered concurrently with alternative maintenance therapy for acute lymphocytic leukemia (30) or because IFN-␣ therapy was administered for less than 6 months (31). And one study was excluded because it did not contain a 6-month follow-up for assessment of HCV PCR (32).…”