Long-term follow-up of HCV-infected hematopoietic SCT patients and effects of antiviral therapy

Abstract

This prospective study was initiated in 1993 with the aim to study late effects and responses to antiviral therapy in a cohort of hepatitis C virus (HCV)-infected patients. A total of 195 patients were included from 12 centers. In all, 134 patients had undergone allogeneic and 61 autologous hematopoietic SCT (HSCT). The median follow-up from HSCT is currently 16.8 years and the maximum 27.2 years. Overall 33 of 195 patients have died of which 6 died from liver complications. The survival probability was 81.6% and the cumulative incidence for death in liver complications was 6.1% at 20 years after HSCT. The cumulative incidence of severe liver complications (death from liver failure, cirrhosis and liver transplantation) was 11.7% at 20 years after HSCT. In all, 85 patients have been treated with IFN; 42 in combination with ribavirin. The sustained response rate was 40%. The rates of severe side effects were comparable to other patient populations and no patient developed significant exacerbations of GVHD. Patients receiving antiviral therapy had a trend toward a decreased risk of severe liver complications (odds ratio ¼ 0.33; P ¼ 0.058). HCV infection is associated with morbidity and mortality in long-term survivors after HSCT. Antiviral therapy can be given safely and might reduce the risk for severe complications.

Effect of Hepatitis C Virus Infection in Patients With Cancer: Addressing a Neglected Population

“…Why G-1-infected patients had life-saving chemotherapy 36 ; it may also delay or prevent progression to cirrhosis or hepatic decompensation in patients with cancer, as reported in other patients (eg, normal hosts, solid organ transplant or HCT recipients). 9,[12][13][14] Furthermore, HCV therapy may reduce the risk of second primary cancers, such as HCC, as described in other infected patients, 37 and improve the recurrence-free and overall survival rates of patients with selected cancers, such as those with HCV-related HCC. 38,39 The overall safety and tolerability of HCV treatment in these patients were similar to those reported for other difficult-to-treat patients (eg, those with HIV coinfection).…”

“…However, studies have demonstrated the feasibility of using pegylated IFN (pegIFN) alfa plus ribavirin in a subset of patients with cancer, such as hepatocellular carcinoma (HCC) survivors, 11 or recipients of hematopoietic cell transplants (HCTs). [12][13][14] Clinical trials of antiviral treatment exclude HCV-infected patients with cancer, likely because of the impact in long-term outcomes of the underlying malignancy, and limited clinical understanding of potential drug-drug interactions between antivirals and chemotherapy or other immunosuppressive agents in these patients.…”

“…15 Patients with cancer may benefit from HCVftherapy because persistent transaminase elevation as a result of chronic infection can make cancer treatment complicated. 16 In addition, successful HCV therapy can cure HCV, prevent its reactivation, 17 delay progression to cirrhosis, [12][13][14] and improve overall mortality rates, as observed in the general population of HCV-monoinfected and HIV-HCV-coinfected patients. 18,19 Few data exist on patients with cancer, but HCV treatment is recommended for all HCT recipients who meet certain criteria, 20 because HCV infection is associated with a higher risk for nonrelapse-related mortality after allogeneic HCT.…”

Safety of allogeneic hematopoietic stem cell transplantation in beta‐thalassemia patients with chronic hepatitis C infections treated at a pediatric center

“…10 Long term, there is also an increased risk for developing cirrhosis, hepatic dysfunction, and hepatocellular carcinoma at an accelerated rate, as early as 7 months post-transplant. [10][11][12][13][14][15] As a result of the limited number of HCV-positive pediatric patients with beta-thalassemia undergoing a HSCT, there is relatively minimal information on the appropriate clinical course of management. In addition, the development of DAAs for treatment of HCV has provided a highly efficacious treatment for eradicating the infection.…”

Treatment of hepatitis C in a pediatric patient using simeprevir and sofosbuvir immediately after an umbilical cord blood transplantation

“…1 Studies have consistently demonstrated that HCV infection increases the risk for early non-relapse mortality after HSCT. [2][3][4] HCV-infected HSCT recipients are more likely to develop sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GvHD), hepatic inflammation and fatal liver failure compared with non-HCV-infected HSCT recipients. Long term, there is also an increased risk for developing cirrhosis and hepatocellular carcinoma at an accelerated rate.…”