Published online 14 January 2009
Haematologica, Vol 94, Issue 2, 249-257 doi:10.3324/haematol.13756
Copyright © 2009 by Ferrata Storti Foundation
Carlos A. Ramos1 ,
Rima M. Saliba1 ,
Leandro de Pádua1 ,
Ola Khorshid1 ,
Elizabeth J. Shpall1 ,
Sergio Giralt1 ,
Poliana A. Patah2 ,
Chitra M. Hosing1 ,
Uday R. Popat1 ,
Gabriela Rondon1 ,
Issa F. Khouri1 ,
Yago L. Nieto1 ,
Richard E. Champlin1 ,
Marcos de Lima1
Haematologica, Vol 94, Issue 2, 249-257 doi:10.3324/haematol.13756
Copyright © 2009 by Ferrata Storti Foundation
Stem Cell Transplantation |
Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies
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.
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Haematologica 2009 94: 170-172.
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  G. Socie, R. P. de Latour, and G. B. McDonald Hepatitis C virus and allogeneic stem cell transplantation still matters! Haematologica, February 1, 2009; 94(2): 170 - 172. [Full Text] [PDF]
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