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Treatment of chronic hepatitis C virus in allogeneic bone marrow transplant recipients
R Peffault de Latour1, T Asselah, V Lévy
1Service d'Hématologie - Greffe de Moelle Osseuse, et Université Paris VII, Hôpital Saint Louis, Paris Cedex, France.
Insights
Hepatitis C virus (HCV) treatment in stem cell transplant (SCT) recipients is challenging. Combined therapy with interferon and ribavirin shows efficacy and manageable safety, challenging previous concerns.
Area of Science:
- Hepatology
- Transplantation Immunology
- Viral Hepatitis
Background:
- Increased incidence of cirrhosis observed in hepatitis C virus (HCV)-infected stem cell transplant (SCT) recipients.
- Limited literature exists on the treatment of HCV in this specific patient population.
- HCV-related liver lesions requiring therapy were identified in 36 out of 99 HCV-infected HCT recipients.
Purpose of the Study:
- To describe the experience and outcomes of treating HCV-infected HCT recipients.
- To evaluate the efficacy and safety of anti-HCV therapies in this patient group.
- To assess the feasibility of combined therapy (interferon and ribavirin) in SCT recipients.
Main Methods:
- Retrospective analysis of 99 HCV-infected HCT recipients.
- Treatment decisions based on HCV RNA levels, liver biopsy findings, and contraindications.
- Comparison of outcomes between patients receiving interferon alone versus combined therapy with ribavirin.
Main Results:
- Only 61% (22/36) of eligible patients could be treated due to contraindications.
- Sustained virological response rates were 20% (4/18) with combined therapy versus 10% (2/20) with interferon alone.
- Hematological toxicity, particularly thrombocytopenia, was more frequent with combined therapy but manageable.
Conclusions:
- Combined therapy demonstrates efficacy in treating HCV in SCT recipients.
- Safety concerns associated with combined therapy may be overestimated in this population.
- Further investigation into optimizing HCV treatment strategies for SCT recipients is warranted.
Abstract:
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=9, or standard IFN: n=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=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.
