Treatment of chronic hepatitis C virus in allogeneic bone marrow transplant recipients

Abstract

Summary:We recently reported an increased incidence of cirrhosis in hepatitis C virus (HCV)-infected stem cell transplant (SCT) recipients. Here, we describe our experience in the treatment of these patients, which has been, to date, poorly reported in the literature. Among 99 HCV-infected HCT recipients, 36 had HCV-related liver lesions on biopsy requiring therapy. Owing to HCV treatment contraindications, only 61% of patients (22/36) could be treated. In all, 12 patients received more than one course of anti-HCV treatment if they had HCV RNA still detectable after the first course of treatment and no treatment contraindications. Combined therapy (pegylated interferon (IFN): n ¼ 9, or standard IFN: n ¼ 9, in combination with ribavirin) led to sustained virological response in 4/18 (20%) patients as compared to 2/20 (10%) in patients who received IFN alone. Hematological toxicity was more frequent with combined therapy. While anemia responded to erythropoietin and/or dose modification, thrombocytopenia usually led to treatment interruption (n ¼ 3). This study thus highlights the efficacy of combined therapy and emphasizes the fact that the undue safety concerns are not a problem when treating this particular population.

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

“…The data suggest that the response and relapse rates of HCV infection after antiviral therapy in our patient cohort are similar to what can be found in other patient groups and higher than what was found by Peffault de Latour et al 13 It should, however, be noted that PCR follow-up data is lacking on 20% of the patients but if we only look at the patients for whom data are known, 34/56 (61%) had sustained virological responses and even if all patients without follow-up are counted as failures (which is an unlikely scenario), the sustained response rate was 40% compared with 20% in the study by Peffault de Latour et al 13 and similar to what was found in a recent study of non-HSCT patients. 19 More importantly, the therapy seemed to be safe with frequencies and types of significant side effects similar to what can be found in other patient populations and no patient was reported to need discontinuation of antiviral therapy due to an exacerbation of chronic GVHD.…”

“…In a separate paper, the same group from Paris reported data on 22 patients who had received antiviral therapy. 13 This study is until now the largest reporting the outcome of antiviral therapy in HCV-infected HSCT recipients. In our cohort, 85 patients (45.6%) have until now received IFN-based antiviral therapy with a response rate of 50% assessed as becoming PCR negative.…”

HCV and Chemotherapy: Does Infection Change Management?

“…Nonetheless, antiviral therapy has been successful in patients after BMT once pancytopenia has resolved [49]. Treatment of immunocompetent, non-cirrhotic genotypes 2 and 3 patients with pegylated interferon and ribavirin for 6 months results in cure 80% of the time.…”

Hepatitis C virus and allogeneic stem cell transplantation still matters!

“…While anemia could be easily managed with dose modification and/or erythropoietin, thrombocytopenia mostly led to treatment interruption. 21 There is no published experience with newer antiviral approaches (protease and polymerase inhibitors) to HCV infection in transplant survivors.…”