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

Abstract

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.

• Authors: Carlos A Ramos, Rima M Saliba, Leandro de Pádua, Ola Khorshid, Elizabeth J Shpall, Sergio Giralt, Poliana A Patah, Chitra M Hosing, Uday R Popat, Gabriela Rondon, Issa F Khouri, Yago L Nieto, Richard E Champlin, Marcos de Lima
• Journal: Haematologica (Haematologica) Vol. 94 Issue 2 Pg. 249-57 (Feb 2009) ISSN: 1592-8721 [Electronic] Italy
• PMID: 19144658 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Case-Control Studies
• Hematologic Neoplasms (complications, mortality, therapy)
• Hematopoietic Stem Cell Transplantation (mortality)
• Hepacivirus
• Humans
• Middle Aged
• Retrospective Studies
• Survival Rate
• Transplantation, Homologous
• Treatment Outcome