Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies

• Published in: Haematologica (Roma) Vol. 94; no. 2; pp. 249 - 257
• Main Authors: Ramos, Carlos A, Saliba, Rima M, de Padua, Leandro, Khorshid, Ola, Shpall, Elizabeth J, Giralt, Sergio, Patah, Poliana A, Hosing, Chitra M, Popat, Uday R, Rondon, Gabriela, Khouri, Issa F, Nieto, Yago L, Champlin, Richard E, de Lima, Marcos
• Format: Journal Article
• Language: English
• Published: Pavia Ferrata Storti Foundation 01.02.2009
• Subjects: Adult; Aged; Biological and medical sciences; Case-Control Studies; Hematologic and hematopoietic diseases; Hematologic Neoplasms - complications; Hematologic Neoplasms - mortality; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation - mortality; Hepacivirus; Humans; Medical sciences; Middle Aged; Original; Retrospective Studies; Survival Rate; Transplantation, Homologous; Treatment Outcome; transplant-related mortality; Seropositivity; Hematology; Stem cell; Mortality; Hematopoietic cell; Homograft; Malignant hemopathy; Survival; Virus; hematopoietic stem cell transplantation; Graft; Flaviviridae; Hepatitis C virus; Hepacivirus; Cancer
• ISSN: 0390-6078; 1592-8721
• DOI: 10.3324/haematol.13756

1 Department of Stem Cell Transplantation and Cellular Therapy, the University of Texas M. D. Anderson Cancer Center, Houston, TX, USA 2 Departamento de Oncologia, Hospital Sírio-Libanês, São Paulo, Brazil Correspondence: Marcos de Lima, MD, Associate Professor of Medicine, Department of Stem Cell, Transplantation and Cellular Therapy, The University of Texas M.D., Anderson Cancer Center 1515 Holcombe Blvd., Unit 423, Houston, TX 77030, Phone: 713-792-8750, E-mail: mdelima{at}mdanderson.org Background: Because hepatitis C virus infection causes hepatic and immunological dysfunction, we hypothesized that seropositivity for this virus could be associated with increased non-relapse mortality after allogeneic hematopoietic stem cell transplantation. Design and Methods: We performed a case-control study of the outcomes of patients who were hepatitis C virus seropositive at the time of allogeneic hematopoietic stem cell transplantation (N=31). Patients positive for hepatitis C virus were considered candidates for stem cell transplantation only if they had no significant evidence of hepatic dysfunction. Matched controls (N=31) were seronegative for viral hepatitides and were paired according to age, diagnosis, disease stage, conditioning regimen and donor type. We also compared the hepatitis C virus seropositive patients to all seronegative patients (all controls, N=1800) transplanted during the same period, to adjust for other confounding effects. Results: The median age of the seropositive patients was 49 (range 26–72); 15 had acute myeloid leukemia/myelodysplastic syndrome, 6 had chronic myeloid leukemia/myeloproliferative disease, 6 non-Hodgkin’s lymphoma, 2 myeloma, 1 acute lymphocytic leukemia and 1 Hodgkin’s lymphoma; 61% had poor risk disease; 68% had related donors; 68% received reduced intensity conditioning; 7 patients had mildly abnormal alanine transaminase levels (all less than three times the upper limit of normal) and 1 patient had minimally elevated bilirubin. These characteristics were similar to those of the matched control group. Median overall survival was 3, 18 and 20 months, and 1-year survival was 29%, 56% and 56%, in the hepatitis C virus, matched and all controls groups, respectively (hazard ratio for death 3.1, 95% confidence interval 1.9–5.6, p <0.001 in multivariate analysis). Non-relapse mortality at 1 year was 43%, 24% and 23%, respectively (hazard ratio 3.3, 95% confidence interval 1.8–7.1, p <0.01). Disease progression and graft-versus-host disease rates were comparable. Conclusions: Hepatitis C virus seropositivity is a significant risk factor for non-relapse mortality after allogeneic hematopoietic stem cell transplantation even in patients with normal or minimally abnormal liver function tests. Key words: hematopoietic stem cell transplantation, hepatitis C virus, transplant-related mortality. Related Article Hepatitis C virus and allogeneic stem cell transplantation still matters! Gérard Socié, Régis Peffault de Latour, George B. McDonald Haematologica 2009 94: 170-172. [Full Text] [PDF]