Long-Term Monitoring of Patients with Hematological Malignancies and Hepatitis B and Hepatitis C Virus Infections

Abstract

INTRODUCTION. Patients (pts) with hematological malignancies are at high risk of infection by Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) due to multiple transfusions and the large number of invasive procedures. The aim of the study was to evaluate the presentation rate of clinical hepatitis, pt survival and how hepatitis infection influenced survival. RESULTS. The study group was comprised of all pts admitted to the hematology department from Feb 2004 to June 2006. The pts were followed until June 2008. All pts were monitored by testing of HBsAg, anti-HCV, DNA-HBV, RNA-HCV, HBeAg, anti-HBs, anti-HBc, anti-HBe approximately every 3 weeks. Liver biopsy was performed on 64 pts, 23 pts each with HBV and HCV immunohistology. A total of 7800 biological samples were collected for HBV and HCV testing; of these, 4000 were tested by PCR methods. Acute leukemias (AL) and aplastic anemias (AA) constituted 77% (205/265) of all pts. The median age was 38 years (range, 15 to 79), Male; 47% (n=125), female; 53% (n=140). Median transfusion load (the number of donors per pt for the study period) was 45 (range, 0 to 418). When patients new to the hematology dept were examined: HBV was detected in 15% (39/265) of new pts and HCV in 7% (19/265) of new pts respectively. We postulated that the rate of infection is extremely high in the hematology clinic. For the entire study period from Feb 2004 to Jun 2006, 51% (135/265) pts had positive markers for HBV infection, 19% (51/265) pts had positive markers for HCV, and 14% (37/265) pts had positive markers for both HBV+HCV. We have shown that up to 95% of HCV-positive pts and up to 60% of HBV-positive pts developed clinical and biochemical symptoms and signs of viral hepatitis with 3 years of initial detection of HBV and HCV markers. 154 (58%) pts survived, 111 (42%) pts died. Of these, 2 pts developed fulminant liver failure due to severe hepatitis B. The analysis of survival risk factors demonstrates that the expected life duration significantly decreases after HBV infection. For AL pts RR=1.8 (p=0,034), for AA pts RR=4.3 (p=0,022). There was no significant association between the expected life duration and HCV infection. Proportional hazard regression model with time dependent covariates (PHREG SAS) was used for the analysis. CONCLUSION. The majority of pts infected by HBV and HCV developed clinically recognizable viral hepatitis within 3 years from the first detection of viral markers. Pts with severe immunosupression often do not manifest obvious features of acute viral hepatitis. Pts with hematological malignances should be monitored regularly (at least once in a month) for HBV and HCV markers during all period of treatment and for 1–2 years after completion of therapy. Viral hepatitis B is a risk factor associated with survival risk factor for AL and AA pts.