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Diaz ACMB, Witkin SS, de Almeida C, Mendrone A, Rocha V, Costa SF, Ramos JF, Mendes-Correa MC. Prevalence and clinical consequences of Hepatitis C virus infection in patients undergoing hematopoietic stem cell transplantation. Rev Inst Med Trop Sao Paulo 2024; 66:e11. [PMID: 38324877 PMCID: PMC10846481 DOI: 10.1590/s1678-9946202466011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/20/2023] [Indexed: 02/09/2024] Open
Abstract
Hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality among hematopoietic stem cell transplant (HCT) recipients. In Brazil, its occurrence in HCT recipients remains undetermined. We now report on HCV prevalence in HCT recipients and its clinical consequences. The medical records of all HCT recipients seen at Hospital das Clinicas, Sao Paulo University Medical School, from January 2010 to January 2020 were reviewed to determine HCV serostatus. A retrospective analysis of medical charts was undertaken on all seropositive cases to determine HCV genotype, presence of liver fibrosis, co-infections with other viruses, previous treatments, and clinical evolution of liver pathology after HCT. Of the 1,293 HCT recipients included in the study, seven (0.54%) were HCV antibody-positive and five (0.39%) were also viremic for HCV-RNA. Four of these individuals had moderate to severe liver fibrosis (METAVIR F2/F3) and one was cirrhotic. Two of the viremic patients developed acute liver dysfunction following transplantation. All patients had their acute episode of liver dysfunction resolved with no further complications. Four of the viremic patients were treated for HCV infection with direct acting agents (DAA). Information regarding HCV treatment was lacking for one of the viremic HCV patients due to loss of follow up. Sustained anti-virologic responses were observed in three cases after the use of DAA. The detection of HCV in hematological adults undergoing HCT and its successful treatment with DAA highlight the necessity of testing for HCV both prior to and following transplantation.
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Affiliation(s)
- Ana Claudia Marques Barbosa Diaz
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica em Virologia (LIM-52), São Paulo, São Paulo, Brazil
| | - Steven Sol Witkin
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica em Virologia (LIM-52), São Paulo, São Paulo, Brazil
- Weill Cornel Medicine, Department of Obstetrics and Gynecology New York, New York, USA
| | - Cesar de Almeida
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Ciências Médicas, São Paulo, São Paulo, Brazil
| | - Alfredo Mendrone
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Hematologia, Laboratório de Investigação Médica em Patogênese e Terapia Dirigida em Onco-Imuno-Hematologia (LIM-31), São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Fundação Pró-Sangue, Hemocentro de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Hematologia, Laboratório de Investigação Médica em Patogênese e Terapia Dirigida em Onco-Imuno-Hematologia (LIM-31), São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratorio de Investigação Médica em Virologia (LIM-49, São Paulo, São Paulo, Brazil
| | - Jessica Fernandes Ramos
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, São Paulo, Brazil
| | - Maria Cassia Mendes-Correa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica em Virologia (LIM-52), São Paulo, São Paulo, Brazil
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2
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Dezan MGF, Cavalcante LN, Cotrim HP, Lyra AC. Hepatobiliary disease after bone marrow transplant. Expert Rev Gastroenterol Hepatol 2023; 17:129-143. [PMID: 36655915 DOI: 10.1080/17474124.2023.2169671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Bone marrow transplantation (BMT) is the standard treatment for several hematologic pathologies. Post-BMT patients may develop hepatobiliary complications that impact morbidity and mortality. The differential diagnosis may include drug-induced liver injury (DILI), sepsis-associated liver injury (SALI), sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GVHD), viral hepatitis, ischemic and fulminant hepatitis, among others. AREA COVERED Defining the etiology of hepatobiliary injury is challenging due to the overlapping symptoms. Thus, it is necessary to be aware of and understand the clinical characteristics of these hepatobiliary complications and provide adequate management with possible better outcomes. We reviewed the scientific literature focused on early hepatobiliary complications associated with BMT. We searched the PubMed database using the following descriptors: hepatic complications, drug-induced liver disease, graft-versus-host disease, cholestasis, sepsis, sinusoidal obstruction syndrome, cytomegalovirus, viral hepatitis, bone marrow transplantation, and hematopoietic stem cell transplantation. EXPERT OPINION Post-BMT hepatobiliary complications comprise several differential diagnoses and are challenges for the hepatologist's clinical practice. When evaluating these patients, it is necessary to consider the temporality between the use of certain medications, the increase in liver enzymes, and the presence of infection, in addition to applying diagnostic criteria and complementary tests for a specific diagnosis.
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Affiliation(s)
- Maria Gabriela Fernandes Dezan
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lourianne Nascimento Cavalcante
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Helma Pinchemel Cotrim
- Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Andre Castro Lyra
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
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3
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Mizuno S, Takami A, Takamatsu H, Hanamura I, Shimazu Y, Hangaishi A, Tsukada N, Kako S, Kikuchi T, Ota S, Shimizu H, Iida S, Yoshioka S, Sawa M, Fukuda T, Kanda Y, Atsuta Y, Kawamura K. Autologous hematopoietic cell transplantation for myeloma patients with hepatitis B virus or hepatitis C virus in the era of novel agents. Bone Marrow Transplant 2022; 57:846-848. [PMID: 35332303 DOI: 10.1038/s41409-022-01640-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan.
| | - Akiyoshi Takami
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroyuki Takamatsu
- Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences/ Faculty of Transdisciplinary Sciences, Institute of Transdisciplinary Sciences, Kanazawa University, Kanazawa, Japan
| | - Ichiro Hanamura
- Division of Hematology, Department of Internal Medicine, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yutaka Shimazu
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
| | - Akira Hangaishi
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuhiro Tsukada
- Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Hiroaki Shimizu
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Hospital, Nagoya, Japan
| | - Satoshi Yoshioka
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.,Division of Hematology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Koji Kawamura
- Department of Hematology, Tottori University Hospital, Yonago, Japan
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4
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Cacoub P, Comarmond C, Vieira M, Régnier P, Saadoun D. HCV-related lymphoproliferative disorders in the direct-acting antiviral era: From mixed cryoglobulinaemia to B-cell lymphoma. J Hepatol 2022; 76:174-185. [PMID: 34600000 DOI: 10.1016/j.jhep.2021.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023]
Abstract
HCV has been shown to induce many B-cell lymphoproliferative disorders. B lymphocytes specialise in producing immunoglobulins and, during chronic HCV infection, they can cause manifestations ranging from polyclonal hypergammaglobulinaemia without clinical repercussions, through mixed cryoglobulinaemic vasculitis to B-cell non-Hodgkin lymphoma. This spectrum is supported by substantial epidemiological, pathophysiological and therapeutic data. Many, although not all, of the pathogenic pathways leading from one extreme to another have been decrypted. Chronic viral antigen stimulation of B lymphocytes has a central role until the final steps before overt malignancy. This has direct implications for treatment strategies, which always include the use of direct-acting antivirals sometimes alongside immunosuppressants. The role of direct-acting antivirals has been well established in patients with cryoglobulinaemia vasculitis. However, their positive impact on B-cell non-Hodgkin lymphoma needs to be confirmed in larger studies with longer follow-up.
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Affiliation(s)
- Patrice Cacoub
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France.
| | - Cloé Comarmond
- AP-HP, Lariboisière Hospital, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Matheus Vieira
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
| | - Paul Régnier
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
| | - David Saadoun
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, F-75013, Paris, France; Institut National de la Santé et de la Recherche Médicale, INSERM, UMR_S 959, F-75013, Paris, France; CNRS, FRE3632, F-75005, Paris, France; Sorbonne Université, UPMC Univ Paris 06, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France
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5
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Mikulska M, Knelange N, Nicolini LA, Tridello G, Santarone S, Di Bartolomeo P, de la Camara R, Cuéllar C, Velardi A, Perruccio K, Ljungman P, Zaucha J, Piekarska A, Basak G, Karakulska-Prystupiuk E, Angelucci E, Ciceri F, Lupo-Stanghellini MT, Fouillard L, García-Cadenas I, Menconi M, Blau IW, Nassi L, Cesaro S, Styczynski J. Efficacy, safety and feasibility of treatment of chronic HCV infection with directly acting agents in hematopoietic stem cell transplant recipients - Study of infectious diseases working party of EBMT. J Infect 2021; 84:71-79. [PMID: 34757138 DOI: 10.1016/j.jinf.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Limited data is available on HCV directly acting agents (DAAs) in haematopoietic stem cell transplant (HSCT) recipients. This study aimed at reporting the characteristics, treatment practices and treatment efficacy in HSCT recipients with chronic HCV. METHODS Prospective observational study from EBMT Infectious Diseases Working Party (IDWP). Patients with chronic HCV infection were included. RESULTS Between 12/2015 and 07/2018, 45 patients were included: male in 53%; median age 49 years (range, 8-75); acute leukaemia in 48.9%, lymphoma in 17.7%, non-malignant disorders in 22.3%; allogeneic HSCT in 84%; 77.8% no immunosuppressive treatment. Genotypes 1, 2, 3 and 4 were detected in 54.5%, 20.5%, 13.6% and 11.4%, respectively; advanced fibrosis in 40%, including cirrhosis in 11.4%. Overall, 37 (82.2%) patients received DAAs, at a median of 8.4 years after HSCT (16.2% within 6 months from HSCT). Sofosbuvir-based treatment was given to 62.2%. Thirty-five patients completed planned treatment course, with sustained virological response (SVR) of 89.1%, and 94.3% (33/35) in those who completed the treatment. Side effects possibly related to DAAs were reported in 5 (14%) and did not require treatment discontinuation. CONCLUSIONS DAAs treatment was effective, safe and feasible in this cohort of mainly allogeneic HSCT recipients with mild/moderate liver damage.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL) and IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi, 10, Genova 16132, Italy.
| | - Nina Knelange
- Department Medical Statistics & Bioinformatics, EBMT Data Office, Leiden, the Netherlands
| | - Laura Ambra Nicolini
- Division of Infectious Diseases, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gloria Tridello
- Paediatric Haematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stella Santarone
- Dipartimento Oncologia Ematologia, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | - Paolo Di Bartolomeo
- Dipartimento Oncologia Ematologia, Terapia Intensiva Ematologica, Ospedale Civile, Pescara, Italy
| | | | - Clara Cuéllar
- Department of Hematology, Hospital 12 de Octubre, Madrid, Spain
| | - Andrea Velardi
- Department of Medicine, Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy
| | - Katia Perruccio
- Pediatric Oncology Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Per Ljungman
- Department for Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Jan Zaucha
- University Hospital Department of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Piekarska
- University Hospital Department of Haematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Basak
- Department of Hematology, Transplantation and Internal Medicine, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland; Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Karakulska-Prystupiuk
- Department of Hematology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Emanuele Angelucci
- Ematologia e Centro Trapianti, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy; School of Medicine, Vita-Salute San Raffaele University, Milano, Italy
| | | | | | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Sant Pau and Jose Carreras Leukemia Research Institutes, Autonomous University of Barcelona, Barcelona, Spain
| | - Mariacristina Menconi
- Unità Operativa Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Pisa, Pisa, Italy
| | | | - Luca Nassi
- Division of Hematology, Department of Translational Medicine, Universita' del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carita, Novara, Italy
| | - Simone Cesaro
- Paediatric Haematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Jan Styczynski
- Department of Pediatric Hematology and Oncology, University Hospital, Collegium Medicum UMK Torun, Bydgoszcz, Poland
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6
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Secondary malignancies after transplantation for aplastic anemia. Bone Marrow Transplant 2021; 56:2324-2325. [PMID: 34234294 DOI: 10.1038/s41409-021-01400-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/17/2021] [Accepted: 06/24/2021] [Indexed: 11/09/2022]
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7
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Manrai M, George E, Kapoor R. Profile of Hepatobiliary Dysfunction in Hematopoietic Stem Cell Transplant Recipients - An Indian Perspective. J Clin Exp Hepatol 2021; 11:14-20. [PMID: 33679044 PMCID: PMC7897852 DOI: 10.1016/j.jceh.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Hematopoietic stem cell transplantation (HSCT) is an established curative modality for various hematological malignancies and other diseases. Hepatobiliary dysfunction and subsequent sequelae constitute a common cause of morbidity and mortality in post-transplant scenario. However, data among Indian HSCT recipients is lacking. METHODS One hundred and one HSCT recipients (37 prospective and 64 retrospective) were followed up for hepatobiliary dysfunction in the post-transplant period. The causes for hepatobiliary dysfunction were categorized as sinusoidal obstruction syndrome (SOS), formerly known as veno-occlusive disease (VOD); acute and chronic graft-versus- host disease (GVHD); drug-induced liver injury (DILI); viral infections and miscellaneous causes including bacterial, fungal and unknown causes based on clinical and laboratory evidence. RESULTS Among the 101 transplants, 56.44% (n = 57) were allogenic transplants, and 43.56% (n = 44) were autologous transplants. Hepatobiliary dysfunction was observed among 71 (70.30%) patients in first 30 days and overall, among 78 (77.23%) patients. Incidence of hepatobiliary dysfunction was higher among allogenic transplant patients compared to autologous transplants (91.23% vs. 59.09%, p < 0.001). The most common cause of hepatobiliary dysfunction reported was Drug-induced liver injury (DILI). In most cases, however, hepatobiliary dysfunction was multifactorial. Sinusoidal obstruction syndrome (15.79%), acute liver GVHD (31.58%), chronic liver GVHD (33.33%) and viral infection/reactivation (26.32%) were reported only in allogenic transplant patients. 15 (14.85%) patients died of which 14 patients had hepatobiliary dysfunction, commonest cause being infections. CONCLUSION Our study reported a higher incidence of hepatobiliary dysfunction among Indian population post HSCT and was associated with significant mortality. In majority of the cases, the cause is multifactorial and pose a diagnostic dilemma and challenges in therapy.
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Key Words
- ALP, Alkaline phosphatase
- ALT, Alanine transaminase
- AST, Aspartate transaminase
- DILI, Drug-induced liver injury
- DNA, Deoxy ribonucleic acid
- GVHD, Graft versus host disease
- HAV, Hepatitis A virus
- HBV, Hepatitis B virus
- HCV, Hepatitis C virus
- HEV, Hepatitis E virus
- HLA, Human leukocyte antigen
- HSCT, Hematopoietic stem cell transplantation
- PCR, Polymerase Chain Reaction
- RNA, Ribonucleic acid
- SOS, Sinusoidal obstruction syndrome
- ULN, Upper limit of normal
- drug induced liver injury
- graft vs host disease
- hematopoietic stem cell transplantation
- hepatobiliary manifestations
- sinusoidal obstruction syndrome
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Affiliation(s)
- Manish Manrai
- Department of Internal Medicine, Armed Forces Medical College, Pune, India
| | - Emil George
- Department of Internal Medicine, INHS Dhanvantari, Port Blair, Andaman & Nicobar Islands, India,Address for correspondence: Dr Emil George, Graded Specialist (Medicine), Department of Internal Medicine, INHS Dhanvantari, Minnie Bay, Port Blair, Andaman & Nicobar Islands, 744103, India.
| | - Rajan Kapoor
- Department of Internal Medicine, Command Hospital, Kolkata, West Bengal, India
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8
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Saunders IM, Tan M, Koura D, Young R. Long-term Follow-up of Hematopoietic Stem Cell Transplant Survivors: A Focus on Screening, Monitoring, and Therapeutics. Pharmacotherapy 2020; 40:808-841. [PMID: 32652612 DOI: 10.1002/phar.2443] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023]
Abstract
Annually, ~50,000 patients undergo hematopoietic stem cell transplantation (HCT) worldwide with almost 22,000 of these patients receiving HCT in the United States. HCT is a curative option for a wide range of hematologic malignancies, and advances in transplantation medicine have resulted in an increase in HCT survivors. It is anticipated that the number of HCT survivors will more than double from 242,000 in 2020 to ~500,000 in 2030. Survivors of HCT are at an increased risk of developing late complications due to exposure to chemotherapy and/or radiation in the pre-, peri-, and post-HCT phases and these cumulative exposures have the potential to damage normal tissue. This tissue damage leads to the early onset of chronic health conditions resulting in premature mortality in HCT survivors, who have a 15-year cumulative incidence of severe or life-threatening chronic health conditions exceeding 40%. Due to the significant burden of morbidity in HCT survivors and the delay in the development of long-term complications, this delicate patient population requires life-long monitoring due to the risk for neuropsychological, cardiac, pulmonary, renal, hepatic, ocular, skeletal, cardiac, endocrine, fertility, and sexual health complications, as well as secondary neoplasms. This review will focus on recent advances in screening, monitoring, and therapeutics for late-occurring or long-term complications in HCT survivors.
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Affiliation(s)
- Ila M Saunders
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - Marisela Tan
- Department of Pharmaceutical Services, San Francisco Medical Center, University of California, San Francisco, California, USA
| | - Divya Koura
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Rebecca Young
- Department of Pharmaceutical Services, San Francisco Medical Center, University of California, San Francisco, California, USA
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9
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Giaccone L, Felicetti F, Butera S, Faraci D, Cerrano M, Dionisi Vici M, Brunello L, Fortunati N, Brignardello E, Bruno B. Optimal Delivery of Follow-Up Care After Allogeneic Hematopoietic Stem-Cell Transplant: Improving Patient Outcomes with a Multidisciplinary Approach. J Blood Med 2020; 11:141-162. [PMID: 32523389 PMCID: PMC7237112 DOI: 10.2147/jbm.s206027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/02/2020] [Indexed: 01/05/2023] Open
Abstract
The increasing indications for allogeneic stem-cell transplant in patients with hematologic malignancies and non-malignant diseases combined with improved clinical outcomes have contributed to increase the number of long-term survivors. However, survivors are at increased risk of developing a unique set of complications and late effects, besides graft-versus-host disease and disease relapse. In this setting, the management capacity of a single health-care provider can easily be overwhelmed. Thus, to provide appropriate survivorship care, a multidisciplinary approach for the long-term follow-up is essential. This review aims at summarizing the most relevant information that a health-care provider should know to establish a follow-up care plan, in the light of individual exposures and risk factors, that includes all organ systems and considers the psychological burden of these patients.
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Affiliation(s)
- Luisa Giaccone
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Francesco Felicetti
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Sara Butera
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Danilo Faraci
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Marco Cerrano
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Margherita Dionisi Vici
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Lucia Brunello
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
| | - Nicoletta Fortunati
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Enrico Brignardello
- Transition Unit for Childhood Cancer Survivors, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Benedetto Bruno
- Division of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Dipartimento di Biotecnologie Molecolari e Scienze per la Salute, University of Torino, Torino, Italy
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10
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Torres HA, Lok AS, Suarez-Almazor ME, Warneke CL, Kaseb A, Miller E, Sturgis EM, Foreman JT, Angelidakis G, Ahmed S, Ferrajoli A, Samaniego F, Hawk ET, Hwang JP. Strategies to identify hepatitis C virus infection in patients receiving anticancer therapy: a cross-sectional study. Support Care Cancer 2020; 29:97-105. [PMID: 32314052 DOI: 10.1007/s00520-020-05456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/01/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Optimal hepatitis C virus (HCV) screening strategies for cancer patients have not been established. We compared the performance of selective HCV screening strategies. METHODS We surveyed patients presenting for first systemic anticancer therapy during 2013-2014 for HCV risk factors. We estimated the prevalence of positivity for HCV antibody (anti-HCV) and examined factors associated with anti-HCV status using Fisher's exact test or Student's t test. Sensitivity was calculated for screening patients born during 1945-1965, patients with ≥ 1 other risk factor, or both cohorts ("combined screening"). RESULTS We enrolled 2122 participants. Median age was 59 years (range, 18-91); 1138 participants were women. Race/ethnicity distribution was white non-Hispanic, 76% (n = 1616); Hispanic, 11% (n = 233); black non-Hispanic, 8% (n = 160); Asian, 4% (n = 78); and other, 2% (n = 35). Primary cancer distribution was non-liver solid tumor, 78% (n = 1664); hematologic cancer, 20% (n = 422); and liver cancer, 1% (n = 28). Prevalence of anti-HCV was 1.93% (95% CI, 1.39%-2.61%). Over 28% of patients with detectable HCV RNA were unaware of infection. Factors significantly associated with anti-HCV positivity included less than a bachelor's degree, birth in 1945-1965, chronic liver disease, injection drug use, and blood transfusion or organ transplant before 1992. A total of 1315 participants (62%), including 39 of 41 with anti-HCV, reported ≥ 1 risk factor. Sensitivity was 80% (95% CI, 65-91%) for birth-cohort-based, 68% (95% CI, 52-82%) for other-risk-factor-based, and 95% (95% 83-99%) for combined screening. CONCLUSION Combined screening still missed 5% of patients with anti-HCV. These findings favor universal HCV screening to identify all HCV-infected cancer patients.
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Affiliation(s)
- Harrys A Torres
- Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anna S Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Maria E Suarez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carla L Warneke
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ethan Miller
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erich M Sturgis
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica T Foreman
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Georgios Angelidakis
- Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sairah Ahmed
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alessandra Ferrajoli
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ernest T Hawk
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica P Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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11
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Torres HA, Pundhir P, Mallet V. Hepatitis C Virus Infection in Patients With Cancer: Impact on Clinical Trial Enrollment, Selection of Therapy, and Prognosis. Gastroenterology 2019; 157:909-916. [PMID: 30797794 DOI: 10.1053/j.gastro.2019.01.271] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Harrys A Torres
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pooja Pundhir
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vincent Mallet
- Université Paris Descartes, Sorbonne Paris Cité and Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin Port Royal and Institut Pasteur, Paris, France
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12
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Ramgopal A, Lauko A, Rotz S, Hanna R. Safety of allogeneic hematopoietic stem cell transplantation in beta-thalassemia patients with chronic hepatitis C infections treated at a pediatric center. Pediatr Transplant 2019; 23:e13520. [PMID: 31209983 DOI: 10.1111/petr.13520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/30/2019] [Accepted: 05/23/2019] [Indexed: 12/11/2022]
Abstract
The outcome of allogeneic HCT in patients previously infected with HCV is a widely debated topic and rarely reported in the pediatric and young adult age group given the small population of affected patients. New medications directly targeting HCV have induced virologic cures for over 90% of patients, and their use in the pretransplant setting may improve outcomes for patients infected with HCV. We describe two patients with transfusion-dependent beta-thalassemia major who underwent matched sibling donor bone marrow transplantation, one with a myeloablative regimen and one with a reduced-intensity conditioning regimen. Allogeneic HCT appears feasible in patients with HCV infection that clear viremia prior to conditioning therapy and with a reduced-intensity conditioning regimen. Further investigation is warranted to better define transplant risks in this population.
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Affiliation(s)
- Archana Ramgopal
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Adam Lauko
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Seth Rotz
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Rabi Hanna
- Department of Hematology Oncology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
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13
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Kaito S, Doki N, Hishima T, Takaki Y, Ohashi K. Progressive Hepatic Cirrhosis Early After Allogeneic Hematopoietic Stem Cell Transplantation in a Patient with Chronic Hepatitis C Infection. Turk J Haematol 2019; 36:130-133. [PMID: 30717587 PMCID: PMC6516096 DOI: 10.4274/tjh.galenos.2019.2018.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Satoshi Kaito
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Hematology Division, Tokyo, Japan
| | - Noriko Doki
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Hematology Division, Tokyo, Japan
| | - Tsunekazu Hishima
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Pathology Division, Tokyo, Japan
| | - Yasunobu Takaki
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Radiology Division, Tokyo, Japan
| | - Kazuteru Ohashi
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Hematology Division, Tokyo, Japan
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14
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Rauwolf K, Herbrüggen H, Zöllner S, Thorer H, Makarova O, Kaiser T, Pettke A, Rossig C, Burkhardt B, Groll AH. Durable control of hepatitis C through interferon-free antiviral combination therapy immediately prior to allogeneic haematopoietic stem cell transplantation. J Viral Hepat 2019; 26:454-458. [PMID: 30516856 DOI: 10.1111/jvh.13046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 12/18/2022]
Abstract
Chronic hepatitis C virus (HCV) infection carries increased risks for morbidity and mortality in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) but has become curable through the advent of directly acting antiviral compounds. Current guidelines of the American Society for Blood and Marrow Transplantation (ASBMT) recommend that HCV-infected HSCT candidates preferably start and complete therapy prior to transplant. However, this is often not feasible due to time constraints or treatment-limiting comorbidities, conditions and treatments. For these reasons, data on the safety of antiviral treatment, its efficacy to achieve durable eradication of the virus until full immune recovery, and late effects of former HCV infection in patients receiving HSCT are unknown. Here, we report the course of two paediatric patients with chronic HCV infection who received a full course of directly acting antivirals prior to allogeneic HSCT and achieved and maintained viral eradication throughout transplantation until complete immune recovery.
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Affiliation(s)
- Kerstin Rauwolf
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Heidi Herbrüggen
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Stefan Zöllner
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Heike Thorer
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Olga Makarova
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Thomas Kaiser
- Department of General Pediatrics, University Children's Hospital Münster, Münster, Germany
| | - Aleksandra Pettke
- Department of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Claudia Rossig
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Birgit Burkhardt
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
| | - Andreas H Groll
- Department of Pediatric Hematology/Oncology, University Children's Hospital Münster, Münster, Germany
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15
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Sood V, Chawla J, Lal BB, Khanna R, Bihari C, Alam S. Hepatic Dysfunction in a Child Post Bone Marrow Transplantation. J Clin Exp Hepatol 2018; 8:327-331. [PMID: 30302052 PMCID: PMC6175742 DOI: 10.1016/j.jceh.2018.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
A 10-year-old female child, a known case of Beta-Thalassemia major with superimposed chronic Hepatitis C Viral (HCV) infection, underwent bone marrow transplantation and presented, 7 months later, with worsening hepatic functions and skin rash. Considering the wide variety of possible etiologies, she was evaluated and later confirmed as a case of hepatic dysfunction secondary to HCV related hepatic injury with concomitant chronic graft versus host disease (dermatological involvement only).
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Key Words
- ALT, Alanine Aminotransferase
- AST, Aspartate Aminotransferase
- BMT, Bone Marrow Transplantation
- DAA, Direct-Acting Antiviral
- DILI, Drug Induced Liver Injury
- GVHD, Graft Versus Host Disease
- HAI, Hepatic Activity Index
- HCV, Hepatitis C Virus
- MRI, Magnetic Resonance Imaging
- RNA, Ribonucleic Acid
- bone marrow transplantation
- graft versus host disease
- pediatric hepatitis C infection
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Affiliation(s)
- Vikrant Sood
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India,Address for correspondence: Vikrant Sood, Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India. Tel.: +91 9711143397.
| | - Juhi Chawla
- Department of Pathology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India
| | - Bikrant B. Lal
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India
| | - Rajeev Khanna
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India
| | - Seema Alam
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India
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16
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Hosoi H, Mushino T, Nishikawa A, Murata S, Kuriyama K, Yamashita Y, Kobata H, Ooiwa T, Hanaoka N, Tamura S, Sonoki T. Marked Elevation of Serum Hyaluronic Acid in Patients Exhibiting Late-Phase Ascites after Allogeneic Hematopoietic Stem Cell Transplantation. Acta Haematol 2018; 139:81-83. [PMID: 29393098 DOI: 10.1159/000486702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Hiroki Hosoi
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Toshiki Mushino
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | | | - Shogo Murata
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Kodai Kuriyama
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Yusuke Yamashita
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Kobata
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Takehiro Ooiwa
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Nobuyoshi Hanaoka
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
- Department of General Medicine, National Hospital Organization Kumamoto Minami Hospital, Kumamoto, Japan
- Department of Hematology, National Hospital Organization Kumamoto Minami Hospital, Kumamoto, Japan
| | - Shinobu Tamura
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
| | - Takashi Sonoki
- Hematology/Oncology, Wakayama Medical University, Wakayama, Japan
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17
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Torres HA, Shigle TL, Hammoudi N, Link JT, Samaniego F, Kaseb A, Mallet V. The oncologic burden of hepatitis C virus infection: A clinical perspective. CA Cancer J Clin 2017; 67:411-431. [PMID: 28683174 PMCID: PMC5591069 DOI: 10.3322/caac.21403] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/18/2022] Open
Abstract
Answer questions and earn CME/CNE Chronic hepatitis C virus (HCV) infection affects millions of people worldwide and is associated with cancer. Direct-acting antivirals (DAAs) have changed HCV treatment paradigms, but little is known about the management of HCV infection in patients with cancer. The substantial burden of HCV infection and the inconclusive evidence regarding its detection and management in patients with cancer prompted the authors to review the literature and formulate recommendations. Patients for whom HCV screening is recommended included all patients with hematologic malignancies, hematopoietic cell transplantation candidates, and patients with liver cancer. There is a lack of consensus-based recommendations for the identification of HCV-infected patients with other types of cancer, but physicians may at least consider screening patients who belong to groups at heightened risk of HCV infection, including those born during 1945 through 1965 and those at high risk for infection. Patients with evidence of HCV infection should be assessed by an expert to evaluate liver disease severity, comorbidities associated with HCV infection, and treatment opportunities. DAA therapy should be tailored on the basis of patient prognosis, type of cancer, cancer treatment plan, and hepatic and virologic parameters. HCV-infected patients with cancer who have cirrhosis (or even advanced fibrosis) and those at risk for liver disease progression, especially patients with HCV-associated comorbidities, should have ongoing follow-up, regardless of whether there is a sustained virologic response, to ensure timely detection and treatment of hepatocellular carcinoma. HCV infection and its treatment should not be considered contraindications to cancer treatment and should not delay the initiation of an urgent cancer therapy. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:411-431. © 2017 American Cancer Society.
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Affiliation(s)
- Harrys A. Torres
- H. A. Torres: Department of Infectious Diseases, Infection Control
and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX,
USA
| | - Terri Lynn Shigle
- T. L. Shigle: Division of Pharmacy, Section of Clinical Pharmacy
Services, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nassim Hammoudi
- N. Hammoudi and V. Mallet: Université Paris
Descartes-Sorbonne Paris Cité; Assistance Publique-Hôpitaux de
Paris, Groupe Hospitalier Cochin Port Royal, Hepatology service; Institut National
de la Santé et de la Recherche Médicale unité 1223; Institut
Pasteur; all in Paris, France
| | - J. T. Link
- J. T. Link and A. Kaseb: Department of Gastrointestinal Medical
Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Felipe Samaniego
- F. Samaniego: Department of Lymphoma & Myeloma, The University
of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Kaseb
- J. T. Link and A. Kaseb: Department of Gastrointestinal Medical
Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vincent Mallet
- N. Hammoudi and V. Mallet: Université Paris
Descartes-Sorbonne Paris Cité; Assistance Publique-Hôpitaux de
Paris, Groupe Hospitalier Cochin Port Royal, Hepatology service; Institut National
de la Santé et de la Recherche Médicale unité 1223; Institut
Pasteur; all in Paris, France
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18
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Atilla E, Atilla PA, Toprak SK, Demirer T. A review of late complications of allogeneic hematopoietic stem cell transplantations. Clin Transplant 2017; 31. [PMID: 28753218 DOI: 10.1111/ctr.13062] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 12/13/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective and curative treatment of different malignant and non-malignant diseases. Early transplant-related mortality after allo-HSCT has decreased with reduced-intensity conditioning regimens and effective anti-infectious treatments, but late transplant-related mortality is still a problem. Physicians are now paying more attention to late complications that may worsen the quality of life of many transplant recipients. Chronic graft versus host disease (cGVHD) is one of the major causes of late transplant-related mortality after allo-HSCT. This review discusses recent advances that have been made in clinical evaluation and treatment of late transplant-related complications including cGVHD. The different sites of involvement are organs, especially the skin and eye, and the gastrointestinal, endocrinologic, metabolic, renal, cardiologic, pulmonary, connective tissue, and neurological systems. In addition, this review includes infections and secondary malignancies in post-transplant settings that worsen quality of life in long-term follow-ups.
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Affiliation(s)
- Erden Atilla
- Department of Hematology, Ankara University Medical School, Ankara, Turkey
| | - Pinar Ataca Atilla
- Department of Hematology, Ankara University Medical School, Ankara, Turkey
| | | | - Taner Demirer
- Department of Hematology, Ankara University Medical School, Ankara, Turkey
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19
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Inamoto Y, Lee SJ. Late effects of blood and marrow transplantation. Haematologica 2017; 102:614-625. [PMID: 28232372 PMCID: PMC5395102 DOI: 10.3324/haematol.2016.150250] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 01/20/2017] [Indexed: 12/22/2022] Open
Abstract
Hematopoietic cell transplantation is a curative treatment for a variety of hematologic diseases. Advances in transplantation technology have reduced early transplant-related mortality and expanded application of transplantation to older patients and to a wider variety of diseases. Management of late effects after transplantation is increasingly important for a growing number of long-term survivors that is estimated to be half a million worldwide. Many studies have shown that transplant survivors suffer from significant late effects that adversely affect morbidity, mortality, working status and quality of life. Late effects include diseases of the cardiovascular, pulmonary, and endocrine systems, dysfunction of the thyroid gland, gonads, liver and kidneys, infertility, iron overload, bone diseases, infection, solid cancer, and neuropsychological effects. The leading causes of late mortality include recurrent malignancy, lung diseases, infection, secondary cancers and chronic graft-versus-host disease. The aim of this review is to facilitate better care of adult transplant survivors by summarizing accumulated evidence, new insights, and practical information about individual late effects. Further research is needed to understand the biology of late effects allowing better prevention and treatment strategies to be developed.
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Affiliation(s)
- Yoshihiro Inamoto
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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20
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Long-Term Incidence of Secondary Malignancies after Allogeneic Hematopoietic Cell Transplantation: A Single-Center Experience. Biol Blood Marrow Transplant 2017; 23:945-951. [PMID: 28254442 DOI: 10.1016/j.bbmt.2017.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/21/2017] [Indexed: 11/24/2022]
Abstract
To review the emergence of secondary malignancies (SMs) in recipients of allogeneic hematopoietic cell transplantation (HCT), we documented the occurrence of SMs in 2415 allogeneic HCT recipients, ages 18 to 71, in a single center over 4 decades. SMs were seen in 209 patients, including 58 with nonmetastatic squamous cell (SCC) and basal cell carcinoma (BCC) of the skin. Cumulative incidence of SM was 6.3% at 10 years, 13.5% at 20 years, and 17.6% at 30 years post-HCT. Median age at diagnosis of SMs was 61 years (range, 21 to 85). By multivariable analysis, older age at HCT was the only independent prognostic factor for SM (HR, 1.39 for ages 41 to 55 and HR, 1.92 for age > 55 compared with age ≤ 40; P = .001). The rate of SM (excluding nonmetastatic SCC/BCC of skin) after HCT was 2.07 times higher (P = .01) compared with the general population. Overall survival (OS) after diagnosis of SM (excluding nonmetastatic SCC/BCC of skin) was 58% at 5 years and 50% at 10 years postdiagnosis. Eastern Cooperative Oncology Group (ECOG) score was the only independent predictor of OS on multivariable analysis, with over 2-fold increased risk of death for patients with an ECOG score of 1 and over 6-fold for ECOG scores of 2 to 4, compared with ECOG score 0 (P < .0001). Forty of 209 patients (19%) diagnosed with SMs subsequently developed another new malignancy. OS was 68% and 51% at 5 and 10 years, respectively. The survival of SM patients post-HCT is favorable, thus warranting diligent long-term cancer screening and standard of care treatment. ECOG status of these patients is a predominant prognostic factor.
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21
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Ullmann AJ, Schmidt-Hieber M, Bertz H, Heinz WJ, Kiehl M, Krüger W, Mousset S, Neuburger S, Neumann S, Penack O, Silling G, Vehreschild JJ, Einsele H, Maschmeyer G. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol 2016; 95:1435-55. [PMID: 27339055 PMCID: PMC4972852 DOI: 10.1007/s00277-016-2711-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/28/2016] [Indexed: 12/13/2022]
Abstract
Infectious complications after allogeneic haematopoietic stem cell transplantation (allo-HCT) remain a clinical challenge. This is a guideline provided by the AGIHO (Infectious Diseases Working Group) of the DGHO (German Society for Hematology and Medical Oncology). A core group of experts prepared a preliminary guideline, which was discussed, reviewed, and approved by the entire working group. The guideline provides clinical recommendations for the preventive management including prophylactic treatment of viral, bacterial, parasitic, and fungal diseases. The guideline focuses on antimicrobial agents but includes recommendations on the use of vaccinations. This is the updated version of the AGHIO guideline in the field of allogeneic haematopoietic stem cell transplantation utilizing methods according to evidence-based medicine criteria.
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Affiliation(s)
- Andrew J Ullmann
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Martin Schmidt-Hieber
- Clinic for Hematology, Oncology und Tumor Immunology, Helios Clinic Berlin-Buch, Berlin, Germany
| | - Hartmut Bertz
- Department of Hematology/Oncology, University of Freiburg Medical Center, 79106, Freiburg, Germany
| | - Werner J Heinz
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Kiehl
- Medical Clinic I, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany
| | - William Krüger
- Haematology and Oncology, Stem Cell Transplantation, Palliative Care, University Hospital Greifswald, Greifswald, Germany
| | - Sabine Mousset
- Medizinische Klinik III, Palliativmedizin und interdisziplinäre Onkologie, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany
| | - Stefan Neuburger
- Sindelfingen-Böblingen Clinical Centre, Medical Department I, Division of Hematology and Oncology, Klinikverbund Südwest, Sindelfingen, Germany
| | | | - Olaf Penack
- Hematology, Oncology and Tumorimmunology, Charité University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Gerda Silling
- Department of Internal Medicine IV, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, German Centre for Infection Research, Partner-site: Bonn-Cologne, University Hospital of Cologne, Cologne, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, Division of Hematology and Oncology, Division of Infectious Diseases, Universitätsklinikum, Julius Maximilian's University, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
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22
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Dropulic LK, Lederman HM. Overview of Infections in the Immunocompromised Host. Microbiol Spectr 2016; 4:10.1128/microbiolspec.DMIH2-0026-2016. [PMID: 27726779 PMCID: PMC8428766 DOI: 10.1128/microbiolspec.dmih2-0026-2016] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 12/12/2022] Open
Abstract
Understanding the components of the immune system that contribute to host defense against infection is key to recognizing infections that are more likely to occur in an immunocompromised patient. In this review, we discuss the integrated system of physical barriers and of innate and adaptive immunity that contributes to host defense. Specific defects in the components of this system that predispose to particular infections are presented. This is followed by a review of primary immunodeficiency diseases and secondary immunodeficiencies, the latter of which develop because of a specific illness or condition or are treatment-related. The effects of treatment for neoplasia, autoimmune diseases, solid organ and stem cell transplants on host defenses are reviewed and associated with susceptibility to particular infections. In conclusion, an approach to laboratory screening for a suspected immunodeficiency is presented. Knowledge of which host defects predispose to specific infections allows clinicians to prevent, diagnose, and manage infections in their immunocompromised patients most effectively.
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Affiliation(s)
- Lesia K Dropulic
- The National Institutes of Health, National Institute of Allergy and Infectious Diseases, Division of Intramural Research, Bethesda, MD 20892
| | - Howard M Lederman
- Departments of Pediatrics, Medicine, and Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287
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23
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How I treat hepatitis C virus infection in patients with hematologic malignancies. Blood 2016; 128:1449-57. [PMID: 27443290 DOI: 10.1182/blood-2016-05-718643] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/12/2016] [Indexed: 12/20/2022] Open
Abstract
Hepatitis C virus (HCV) infection is not uncommon in cancer patients. Over the past 5 years, treatment of chronic HCV infection in patients with hematologic malignancies has evolved rapidly as safe and effective direct-acting antivirals (DAAs) have become the standard-of-care treatment. Today, chronic HCV infection should not prevent a patient from receiving cancer therapy or participating in clinical trials of chemotherapy because most infected patients can achieve virologic cure. Elimination of HCV from infected cancer patients confers virologic, hepatic, and oncologic advantages. Similar to the optimal therapy for HCV-infected patients without cancer, the optimal therapy for HCV-infected patients with cancer is evolving rapidly. The choice of regimens with DAAs should be individualized after thorough assessment for potential hematologic toxic effects and drug-drug interactions. This study presents clinical scenarios of HCV-infected patients with hematologic malignancies, focusing on diagnosis, clinical and laboratory presentations, complications, and DAA therapy. An up-to-date treatment algorithm is presented.
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24
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Severe hepatitis C reactivation as an early complication of hematopoietic cell transplantation. Bone Marrow Transplant 2016; 52:138-140. [PMID: 27427916 DOI: 10.1038/bmt.2016.196] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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25
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Hosoi H, Warigaya K, Murata S, Mushino T, Kuriyama K, Nishikawa A, Tamura S, Hatanaka K, Hanaoka N, Muragaki Y, Murata S, Nakakuma H, Sonoki T. Refractory Ascites with Liver Fibrosis Developed in Late Phase Allogeneic Hematopoietic Stem Cell Transplantation: Report of Three Patients. Hematol Rep 2016; 8:6482. [PMID: 27499838 PMCID: PMC4961872 DOI: 10.4081/hr.2016.6482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 06/17/2016] [Indexed: 02/07/2023] Open
Abstract
We report cases of three patients of refractory ascites without other fluid retention that occurred around five months after allogeneic hematopoietic stem cell transplantation (allo-HSCT). All three patients expired and postmortem examinations revealed unexpected liver fibrosis lacking histological evidences of graft-versus-host-disease (GVHD). The three patients showed normal hepatic function and size before transplantation. During their clinical courses, serum biochemistry test showed no elevation of hepatic enzymes and bilirubin; however, imaging studies demonstrated hepatic atrophy at the onset of ascites. One of the liver specimens showed bile obstruction, which could be seen in hepatic damage by GVHD. Although ascites resulting from venoocclusive disease in early phase allo-HSCT is well documented, ascites associated with hepatic fibrosis in late phase allo-HCST has not been reported. Further clinico-pathological studies on similar patients should be required to ascertain refractory ascites associated with liver fibrosis after allo-HSCT.
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Affiliation(s)
- Hiroki Hosoi
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Kenji Warigaya
- Department of Human Pathology and Diagnostic Pathology, Wakayama Medical University , Wakayama, Japan
| | - Shogo Murata
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Toshiki Mushino
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Kodai Kuriyama
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Akinori Nishikawa
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Shinobu Tamura
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Kazuo Hatanaka
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Nobuyoshi Hanaoka
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Yasuteru Muragaki
- First Department of Pathology, Wakayama Medical University , Wakayama, Japan
| | - Shinichi Murata
- Department of Human Pathology and Diagnostic Pathology, Wakayama Medical University , Wakayama, Japan
| | - Hideki Nakakuma
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
| | - Takashi Sonoki
- Department of Hematology and Oncology, Wakayama Medical University , Wakayama, Japan
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26
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Mallet V, van Bömmel F, Doerig C, Pischke S, Hermine O, Locasciulli A, Cordonnier C, Berg T, Moradpour D, Wedemeyer H, Ljungman P. Management of viral hepatitis in patients with haematological malignancy and in patients undergoing haemopoietic stem cell transplantation: recommendations of the 5th European Conference on Infections in Leukaemia (ECIL-5). THE LANCET. INFECTIOUS DISEASES 2016; 16:606-617. [PMID: 27599653 DOI: 10.1016/s1473-3099(16)00118-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/24/2022]
Abstract
Viral hepatitis affects millions of people worldwide, and host immunity is the key determinant of patient outcome. Viral hepatitis can be life threatening in patients with haematological malignancy, including haemopoietic stem cell transplant recipients, because of the virus itself, or through a need to decrease the dose of chemotherapy. A past or currently infected haemopoietic stem cell donor could also transmit viral hepatitis. The burden of viral hepatitis in patients with haematological malignancies and the weak evidence on which previous guidelines are based has prompted the European Conference on Infection in Leukaemia (ECIL-5) to convene a group of experts in the fields of viral hepatitis and of haematological malignancy to specifically address previously unconsidered issues and grade the available quality of evidence according to the Infectious Diseases Society of America grading system. The group recommends that all patients should be screened for hepatotropic viruses before haematological treatment and that patients or haemopoietic stem cell donors with markers of past or current viral hepatitis should be assessed by an expert. Screening, vaccination, and treatment rules are reported in this Review.
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Affiliation(s)
- Vincent Mallet
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Institut Pasteur, Institut National de la Santé et de la Recherche Médicale Unité 1223, Paris, France; Hepatology Service, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Cochin Port-Royal, Paris, France.
| | | | - Christopher Doerig
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Sven Pischke
- University Medical Center Hamburg-Eppendorf, First Department of Medicine, Hamburg, Germany
| | - Olivier Hermine
- Department of Haematology, Paris Descartes University, Imagine Institute, Necker Hospital, Paris, France
| | - Anna Locasciulli
- Ematologia e Trapianto di Midollo, Ospedale SanCamillo, Roma, Italia
| | - Catherine Cordonnier
- Haematology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, and Paris-Est Créteil University, Créteil, France
| | - Thomas Berg
- Hepatology Section, University Hospital Leipzig, Leipzig, Germany
| | - Darius Moradpour
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | | | - Per Ljungman
- Karolinska University Hospital, Department of Haematology and Karolinska Institutet, Department of Medicine, Huddinge, Stockholm, Sweden
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27
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Wahba MR, Surapaneni M, Chandrasekar PH. Successful therapy with Ledipasvir/Sofosbuvir for hepatitis C reactivation in a hematopoietic stem cell transplant recipient. Leuk Lymphoma 2016; 57:2693-5. [PMID: 26998960 DOI: 10.3109/10428194.2016.1157870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marian R Wahba
- a Department of Medicine, Sinai Grace Hospital, Detroit Medical Center , Wayne State University , Detroit , MI , USA
| | - Malini Surapaneni
- b Department of Medicine, Division of Infectious Diseases , Wayne State University School of Medicine , Detroit , MI , USA
| | - Pranatharthi H Chandrasekar
- b Department of Medicine, Division of Infectious Diseases , Wayne State University School of Medicine , Detroit , MI , USA
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28
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Piñana JL, Serra MÁ, Hernández-Boluda JC, Navarro D, Calabuig M, Solano C. Successful treatment of hepatitis C virus infection with sofosbuvir and simeprevir in the early phase of an allogeneic stem cell transplant. Transpl Infect Dis 2016; 18:89-92. [PMID: 26485423 DOI: 10.1111/tid.12474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/29/2015] [Accepted: 10/08/2015] [Indexed: 01/03/2023]
Abstract
Currently, a lack of consensus exists on how to manage a hepatitis C virus (HCV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Ribavirin alone, or in combination with interferon, has been the mainstream therapy for HCV infection after transplantation. However, very few patients have been regularly treated owing to concerns about poor tolerability, frequent side effects, and limited efficacy. The present case illustrates the striking efficacy of the combination therapy of sofosbuvir with simeprevir, early after transplantation, as it was able to completely eliminate viral replication within 1 month of initiation of treatment. Moreover, tolerance was good, with only minor interactions between the immunosuppressive drugs. This case report supports the feasibility of using this combination therapy early after allo-HSCT for patients with HCV infection.
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Affiliation(s)
- J L Piñana
- Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - M Á Serra
- Gastro-intestinal Disease Unit, Hospital Clínico Universitario, Valencia, Spain
| | - J C Hernández-Boluda
- Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - D Navarro
- Microbiology Service, Hospital Clínico Universitario, Valencia, Spain
| | - M Calabuig
- Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
| | - C Solano
- Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain
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29
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Hilgendorf I, Greinix H, Halter JP, Lawitschka A, Bertz H, Wolff D. Long-term follow-up after allogeneic stem cell transplantation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:51-8. [PMID: 25797423 DOI: 10.3238/arztebl.2015.0051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Over 3000 persons undergo allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in Germany every year. Advances in allo-HSCT have prolonged the survival of treated patients but have concomitantly increased the risk of long-term complications that impair their quality of life. METHODS This literature review of the long-term sequelae of allo-HSCT is based on pertinent articles that were retrieved by a selective search of PubMed, and on current international guidelines. Case reports were excluded from consideration. RESULTS Hardly any randomized clinical trials have been performed to investigate the long-term outcome of allo-HSCT, but international consensus-based guidelines have been published. 50% to 70% of patients treated with allo-HSCT develop chronic graft-versus-host disease (cGVHD) within ten years of treatment. Transplant recipients are at higher risk of infection, including the reactivation of dormant herpes viruses; therefore, vaccination is recommended, as described in the current guidelines. Gonadal dysfunction arises in up to 92% of men and up to 99% of women; its frequency depends on the timing of transplantation, on radiotherapy, and on other factors. The medications that transplant recipients need to take can impair liver function, and transfusionassociated hemosiderosis can do so as well. 40% to 50% of patients suffer from lipid metabolic disturbances that increase the risk of myocardial infarction, peripheral arterial occlusive disease, and stroke. Their life expectancy is shorter than that of the overall population. CONCLUSION Measures should be taken to prevent the potential long-term complications of allo-HSCT. All patients who have been treated with allo-HSCT should receive individualized, risk-adapted, and multidisciplinary follow-up care, so that any complications that arise can be correctly diagnosed and appropriately treated. Long-term follow-up care could be improved by prospective clinical trials investigating the long-term sequelae of allo-HSCT, as well as by consistent, uniform documentation of these sequelae in supraregional data registries.
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Affiliation(s)
- Inken Hilgendorf
- Clinic of Internal Medicine II, University Hospital Jena, University Clinic of Internal Medicine I, Medical University of Vienna, Austria, Department of Hematology, University Hospital of Basel, St. Anna Children's Hospital, Vienna, Austria, Department of Hematology, Oncology, and Stem-Cell Transplantation, Medical Center - University of Freiburg, Department of Internal Medicine III, University Hospital Regensburg
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30
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Treatment of hepatitis C in a pediatric patient using simeprevir and sofosbuvir immediately after an umbilical cord blood transplantation. Bone Marrow Transplant 2016; 51:735-7. [DOI: 10.1038/bmt.2015.309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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31
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Kyvernitakis A, Mahale P, Popat UR, Jiang Y, Hosry J, Champlin RE, Torres HA. Hepatitis C Virus Infection in Patients Undergoing Hematopoietic Cell Transplantation in the Era of Direct-Acting Antiviral Agents. Biol Blood Marrow Transplant 2015; 22:717-722. [PMID: 26712592 DOI: 10.1016/j.bbmt.2015.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/15/2015] [Indexed: 02/06/2023]
Abstract
There is paucity of literature regarding hepatitis C virus (HCV) infection in hematopoietic cell transplant (HCT) recipients. In the study described herein we evaluated several aspects of HCV infection in HCT recipients, including the impact of this infection on cancer status, liver-related outcomes, mortality, and the role of antiviral treatment (AVT), including direct-acting antivirals (DAAs). The medical records of HCV-infected allogeneic and autologous HCT recipients, seen at The University of Texas MD Anderson Cancer Center from August 2009 to November 2015, were reviewed. Patients seen from August 1, 2009 to October 30, 2012 were reviewed retrospectively, whereas those seen from November 1, 2012 to November 30, 2015 were analyzed prospectively in an observational study. Of 434 HCV-infected cancer patients evaluated, 64 underwent 69 HCTs. Most (78%) underwent autologous transplantation. Thirteen percent of patients became HCV-seronegative post-HCT. Compared with patients who did not receive AVT, treated patients had fewer relapses of HCV-associated non-Hodgkin lymphomas (20% versus 86%; P = .015), higher 5-year survival rates (75% versus 39%; P = .02), and a trend toward lower rate of progression to cirrhosis (5% versus 21%; P = .06). AVT discontinuation rate post-HCT was 71% in those receiving IFN-containing regimens and 0% in those receiving DAAs (P < .01). AVT was effective in 12 of 37 patients (32%) and 11 of 13 patients (85%) receiving IFN-based and DAA regimens, respectively (P = .003). HCV is an important cause of morbidity and mortality in this population. HCV seropositivity can be lost post-HCT, posing a diagnostic challenge. Treatment of HCV infection in HCT recipients improves both oncologic and hepatic outcomes. These patients can be successfully treated with DAAs.
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Affiliation(s)
- Andreas Kyvernitakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeff Hosry
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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32
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Kyvernitakis A, Taremi M, Blechacz B, Hwang J, Jiang Y, Mahale P, Torres HA. Impact of hepatitis E virus seropositivity on chronic liver disease in cancer patients with hepatitis C virus infection. Hepatol Res 2015; 45:1146-51. [PMID: 25488194 DOI: 10.1111/hepr.12460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/17/2014] [Accepted: 12/06/2014] [Indexed: 01/17/2023]
Abstract
AIM Immunocompromised patients can develop chronic hepatitis E virus (HEV) infection and progress to cirrhosis. Hepatitis C virus (HCV)-infected cancer patients who have received chemotherapeutic agents experience accelerated liver fibrosis progression. Our aim was to investigate the prevalence and impact of HEV seropositivity on liver-related outcomes in HCV-infected cancer patients. METHODS As part of a prospective study of HCV-infected cancer patients conducted at our center, we investigate the characteristics associated with progression of their liver disease. RESULTS Of the 115 patients tested, 13 (11%) were positive for HEV immunoglobulin G. HEV seropositivity was associated with advanced age (P = 0.004), race (P = 0.02), place of birth outside the USA (P = 0.021), cirrhosis (P = 0.027), history of reused needles/syringes during massive vaccination campaigns (P = 0.015) and coronary artery disease (P = 0.039). Overall, 47 (41%) of the patients had cirrhosis. Factors independently associated with cirrhosis were male sex (odds ratio [OR], 2.8; P = 0.028) and HEV seropositivity (OR, 4.1; P = 0.032). CONCLUSION HEV seropositivity is present in 11% of HCV-infected cancer patients and seems to be associated with cirrhosis. Our results suggest that HEV screening should be implemented in HCV-infected patients with cancer.
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Affiliation(s)
- Andreas Kyvernitakis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mahnaz Taremi
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Boris Blechacz
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica Hwang
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ying Jiang
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Parag Mahale
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Harrys A Torres
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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33
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Torres HA, Chong PP, De Lima M, Friedman MS, Giralt S, Hammond SP, Kiel PJ, Masur H, McDonald GB, Wingard JR, Gambarin-Gelwan M. Hepatitis C Virus Infection among Hematopoietic Cell Transplant Donors and Recipients: American Society for Blood and Marrow Transplantation Task Force Recommendations. Biol Blood Marrow Transplant 2015; 21:1870-82. [PMID: 26256943 DOI: 10.1016/j.bbmt.2015.07.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Harrys A Torres
- The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Pearlie P Chong
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marcos De Lima
- University Hospitals Case Medical Center and University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Sergio Giralt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah P Hammond
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patrick J Kiel
- Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Henry Masur
- National Institutes of Health Clinical Center, Bethesda, Maryland
| | - George B McDonald
- University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
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Modi G, Madabhavi I, Shah S, Shah K, Patel K, Anand A, Panchal H, Patel A, Parikh S. Experience of hematopoietic stem cell transplantation (HSCT) in the patients infected with either hepatitis B or hepatitis C virus. INDIAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.1016/j.ijt.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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35
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Young JAH, Weisdorf DJ. Infections in Recipients of Hematopoietic Stem Cell Transplants. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152282 DOI: 10.1016/b978-1-4557-4801-3.00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Although HCV infection mainly induces liver injury, chronic disease is systemic. Moreover, host and viral factors, as well as comorbidities, may influence the chance of achieving a sustained virological response or disease outcome. Although there are sufficient data on the use of peg-interferon and ribavirin in patients with comorbidities, there is very little data on first generation protease inhibitors, which include significant drug-drug interactions and have therefore been administered with caution in these patients. The availability of new, more effective direct acting antivirals should significantly change this scenario. All these issues are discussed in this review.
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Affiliation(s)
- Vincenzo Boccaccio
- Department of Internal Medicine, A.O. Fatebenefratelli e Oftalmico, Milan, Italy
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37
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New nucleotide polymerase inhibitors to rapidly permit hematopoietic stem cell donation from a positive HCV-RNA donor. Blood 2014; 124:2613-4. [PMID: 25323689 DOI: 10.1182/blood-2014-06-582122] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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38
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Hsiao HH, Liu YC, Wang HC, Wu CH, Cho SF, Hsu JF, Tsai HJ, Hsiao S, Chang CS, Lin SF, Liu TC, Chuang WL, Yu ML. Hepatitis C transmission from viremic donors in hematopoietic stem cell transplant. Transpl Infect Dis 2014; 16:1003-6. [PMID: 25367218 DOI: 10.1111/tid.12306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/30/2014] [Accepted: 08/12/2014] [Indexed: 01/04/2023]
Affiliation(s)
- H.-H. Hsiao
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Faculty of Internal Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Y.-C. Liu
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Faculty of Internal Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - H.-C. Wang
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - C.-H. Wu
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - S.-F. Cho
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - J.-F. Hsu
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - H.-J. Tsai
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - S.Y. Hsiao
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - C.-S. Chang
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Faculty of Internal Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - S.-F. Lin
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Faculty of Internal Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - T.-C. Liu
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Faculty of Internal Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - W.-L. Chuang
- Faculty of Internal Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Hepatobiliary Division; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - M.-L. Yu
- Faculty of Internal Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
- Hepatobiliary Division; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
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39
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Norvell JP. Liver disease after hematopoietic cell transplantation in adults. Transplant Rev (Orlando) 2014; 29:8-15. [PMID: 25315987 DOI: 10.1016/j.trre.2014.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/10/2014] [Accepted: 08/22/2014] [Indexed: 01/22/2023]
Abstract
Liver-related complications constitute a large component of the overall morbidity and mortality associated with hematopoietic cell transplantation. Affecting up to 80% of allogeneic HCT recipients, prompt recognition and treatment are essential. The differential diagnosis is broad and is best categorized by time of onset after transplantation. Early complications include drug-induced liver injury, sinusoidal obstruction syndrome, and graft-versus-host disease. Late complications include infectious sequelae, cirrhosis, and hepatic malignancies. Patients being considered for hematopoietic cell transplantation should be screened and evaluated for liver-related complications to help improve outcomes.
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Affiliation(s)
- J P Norvell
- Department of Medicine, Division of Digestive Diseases, Emory Transplant Center, Emory University, Atlanta, GA, USA.
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. [Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation]. Bone Marrow Transplant 2014; 47:337-41. [PMID: 24975331 DOI: 10.1038/bmt.2012.5] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplantation exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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41
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Puri P, Anand AC, Saraswat VA, Acharya SK, Sarin SK, Dhiman RK, Aggarwal R, Singh SP, Amarapurkar D, Arora A, Chhabra M, Chetri K, Choudhuri G, Dixit VK, Duseja A, Jain AK, Kapoor D, Kar P, Koshy A, Kumar A, Madan K, Misra SP, Prasad MV, Nagral A, Puri AS, Jeyamani R, Saigal S, Shah S, Sharma PK, Sood A, Thareja S, Wadhawan M. Consensus Statement of HCV Task Force of the Indian National Association for Study of the Liver (INASL). Part II: INASL Recommendations for Management of HCV in India. J Clin Exp Hepatol 2014; 4:117-40. [PMID: 25755549 PMCID: PMC4116713 DOI: 10.1016/j.jceh.2014.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022] Open
Abstract
The estimated prevalence of hepatitis C virus (HCV) infection in India is between 0.5 and 1.5% with hotspots showing much higher prevalence in some areas of northeast India, in some tribal populations and in certain parts of Punjab. Genotype 3 is the most prevalent type of infection. Recent years have seen development of a large number of new molecules that are revolutionizing the treatment of hepatitis C. Some of the new directly acting agents (DAAs) like sofosbuvir have been called game-changers because they offer the prospect of interferon-free regimens for the treatment of HCV infection. These new drugs have not yet been approved in India and their cost and availability is uncertain at present. Till these drugs become available at an affordable cost, the treatment that was standard of care for the whole world before these newer drugs were approved should continue to be recommended. For India, cheaper options, which are as effective as the standard-of-care (SOC) in carefully selected patients, are also explored to bring treatment within reach of poorer patients. It may be prudent to withhold treatment at present for selected patients with genotype 1 or 4 infection and low levels of fibrosis (F1 or F2), and for patients who are non-responders to initial therapy, interferon intolerant, those with decompensated liver disease, and patients in special populations such as stable patients after liver and kidney transplantation, HIV co-infected patients and those with cirrhosis of liver.
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Key Words
- ALT, alanine amintraonsferase
- ANC, absolute neutrophil count
- AST, aspartate aminotransferase
- CH–C, Chronic Hepatitis C
- CKD, chronic kidney disease
- CTP, Child-Turcotte-Pugh
- EIA, enzyme immunoassay
- ETR, end-of-treatment response
- EVR, early virological response
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- HCV, hepatitis C virus
- HIV, Human immunodeficiency virus
- IFNa, interferon alfa
- INASL, Indian National Association for Study of the Liver
- PCR, polymerase chain reaction
- Peg-IFNa, pegylated interferon alfa
- RBV, Ribavirin
- RVR, rapid virological response
- SOC, standard of care
- SVR, sustained virological response
- ULN, upper limit of normal
- anti-HCV, antibody to HCV
- antiviral therapy
- chronic hepatitis
- hepatitis C virus
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Affiliation(s)
- Pankaj Puri
- Department of Gastroenterology, Army Hospital (R & R), New Delhi 110010, India
| | - Anil C. Anand
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi 110076, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical, Sciences, Lucknow, Uttar Pradesh 221016, India
| | - Subrat K. Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shiv K. Sarin
- Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and, Research, Chandigarh 160012, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical, Sciences, Lucknow, Uttar Pradesh 221016, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Odisha 753007, India
| | - Deepak Amarapurkar
- Department of Gastroenterology, Bombay Hospital, Mumbai, Maharashtra 400020, India
| | - Anil Arora
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Mohinish Chhabra
- Department of Gastroenterology, Fortis Hospital, Mohali, Punjab 160047, India
| | - Kamal Chetri
- Department of Gastroenterology, International Hospital, Guwahati, Assam 781005, India
| | - Gourdas Choudhuri
- Department of Gastroenterology, Fortis Hospital, Gurgaon, Haryana 122002, India
| | - Vinod K. Dixit
- Department of Gastroenterology, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and, Research, Chandigarh 160012, India
| | - Ajay K. Jain
- Department of Gastroenterology, Choithram Hospital & Research Centre, Indore, Madhya Pradesh 452014, India
| | - Dharmesh Kapoor
- Department of Gastroenterology, Global Hospital, Hyderabad, Andhra Pradesh 500004, India
| | - Premashis Kar
- Department of Gastroenterology, LNJP Hospital, and Maulana Azad Medical College, New Delhi 110002, India
| | - Abraham Koshy
- Department of Hepatology, Lakeshore Hospital, Cochin, Kerala 682304, India
| | - Ashish Kumar
- Department of Gastroenterology and Hepatology, Sir Ganga Ram Hospital, New Delhi 110060, India
| | - Kaushal Madan
- Department of Gastroenterology, Medanta Medicity, Gurgaon, Haryana 122001, India
| | - Sri P. Misra
- Department of Gastroenterology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh 211001 India
| | - Mohan V.G. Prasad
- Department of Gastroenterology, VGM Hospital, Coimbatore, Tamil Nadu 641005, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital, Mumbai, Maharashtra 400026, India
| | - Amarendra S. Puri
- Department of Gastroenterology, GB Pant Hospital, New Delhi 110002, India
| | - R. Jeyamani
- Department of Gastroenterology, Christian Medical College, Vellore, Tamil Nadu 632004, India
| | - Sanjiv Saigal
- Department of Gastroenterology, Medanta Medicity, Gurgaon, Haryana 122001, India
| | - Samir Shah
- Department of Gastroenterology, Global Hospital, Mumbai, Maharashtra 400078, India
| | - Praveen K. Sharma
- Department of Medicine, Armed Forces Medical College, Pune, Maharashtra 411040, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab 141001, India
| | - Sandeep Thareja
- Department of Gastroenterology, Army Hospital (R & R), New Delhi 110010, India
| | - Manav Wadhawan
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospital, New Delhi 110076, India
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42
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Wollmer E, Neubauer A. Komplikationen der allogenen Knochenmark- und Stammzelltransplantation. Internist (Berl) 2014; 55:547-60; quiz 561. [DOI: 10.1007/s00108-013-3432-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Borchardt RA, Torres HA. Challenges in managing hepatitis C virus infection in cancer patients. World J Gastroenterol 2014; 20:2771-2776. [PMID: 24659870 PMCID: PMC3961965 DOI: 10.3748/wjg.v20.i11.2771] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/20/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
Cancer patients have unique problems associated with hepatitis C virus (HCV) infection and treatment not seen in the general population. HCV infection poses additional challenges and considerations for the management of cancer, and vice versa. HCV infection also can lead to the development of cancer, particularly hepatocellular carcinoma and non-Hodgkin lymphoma. In severely immunocompromised cancer patients, diagnosis of HCV infection requires increased reliance on RNA detection techniques. HCV infection can affect chemotherapy, and delay of HCV infection treatment until completion of chemotherapy and achievement of cancer remission may be required to decrease the potential for drug-drug interactions between antineoplastic agents and HCV therapeutics and potentiation of side effects of these agents. In addition, hematopoietic stem cell transplant (HSCT) recipients have an increased risk of early development of cirrhosis and fibrosis. Whether this increased risk applies to all patients regardless of cancer treatment is unknown. Furthermore, patients with cancer may have poorer sustained virological responses to HCV infection treatment than do those without cancer. Unfortunately, not all cancer patients are candidates for HCV infection therapy. In this article, we review the challenges in managing HCV infection in cancer patients and HSCT recipients.
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Tichelli A, Rovó A, Passweg J, Schwarze CP, Van Lint MT, Arat M, Socié G. Late complications after hematopoietic stem cell transplantation. Expert Rev Hematol 2014; 2:583-601. [DOI: 10.1586/ehm.09.48] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Consensus on the histopathological evaluation of liver biopsies from patients following allogeneic hematopoietic cell transplantation. Virchows Arch 2014; 464:175-90. [PMID: 24385287 DOI: 10.1007/s00428-013-1528-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/07/2013] [Accepted: 12/09/2013] [Indexed: 12/13/2022]
Abstract
After allogeneic hematopoietic cell transplantation (alloHCT) liver biopsy is performed for enigmatic liver disorders when noninvasive diagnostic steps have failed in establishing a definitive diagnosis. This document provides an updated consensus on the prerequisites for proper evaluation of liver biopsies in alloHCT patients and the histological diagnostic criteria for liver graft-versus-host disease (GvHD). The Working Group's recommendations for the histological diagnosis of liver GvHD were derived from the peer-reviewed literature and from the consensus diagnosis of a total of 30 coded liver biopsies. Acceptance of the recommendations was tested by a survey distributed to all HCT centers in Austria, Germany and Switzerland. Consensus was achieved for biopsy indications, methods of sample acquisition and processing, reporting and interpretation of biopsy findings. As GvHD is variably treated and the treatment modalities have changed over time, the panel endorses the use of more frequent biopsies in clinical studies in order to improve the present challenging clinical and diagnostic situation.
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46
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Hsu JW, Wingard JR. Advances in the management of viral infections. Cancer Treat Res 2014; 161:157-180. [PMID: 24706224 DOI: 10.1007/978-3-319-04220-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Viral infections are common in cancer patients. The risk and severity of infection are influenced by patient, disease, treatment, and viral factors. Severe viral infections are more likely to occur in treatment regimens that are more immunosuppressive. Historically, the most frequent severe infections have been due to herpesviruses, but more recently, other pathogens, especially community respiratory and hepatitis viruses, have received increasing attention as major viral pathogens in cancer patients. Because of the new diagnostic assays and the introduction of better therapeutic options, knowledge of viral infections is important in optimizing antineoplastic therapies.
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Affiliation(s)
- Jack W Hsu
- Department of Medicine, University of Florida, 1600 SW Archer Road, PO Box 100277, Gainesville, FL, 32610, USA,
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47
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Late Effects in Survivors After Hematopoietic Cell Transplantation in Childhood. PEDIATRIC ONCOLOGY 2014. [DOI: 10.1007/978-3-642-39920-6_7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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48
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Fransen van de Putte DE, Makris M, Fischer K, Yee TT, Kirk L, van Erpecum KJ, Patch D, Posthouwer D, Mauser-Bunschoten EP. Long-term follow-up of hepatitis C infection in a large cohort of patients with inherited bleeding disorders. J Hepatol 2014; 60:39-45. [PMID: 23978717 DOI: 10.1016/j.jhep.2013.08.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 08/04/2013] [Accepted: 08/06/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS Patients with inherited bleeding disorders are an interesting group to study the long-term course of chronic hepatitis C virus (HCV) infection, because of their uniform mode of infection and reliable follow-up. Our aim was to assess the long-term occurrence of adverse liver-related events in these patients. METHODS The occurrence and determinants of end-stage liver disease (ESLD) were assessed using retrospective data of 863 HCV infected patients with inherited bleeding disorders from the Netherlands and the UK. RESULTS Median follow-up since HCV infection was 31 years, while 30% of patients had >35 follow-up years. Nineteen percent of patients spontaneously cleared the virus and 81% developed chronic HCV infection. Of the 700 patients with chronic HCV, 90 (13%) developed ESLD. Hepatocellular carcinoma (HCC) was diagnosed in 3% of patients with chronic HCV, 41% of which occurred in the last six years. Determinants of ESLD development were age at infection (hazard ratio (HR) 1.09 per year increase), HIV co-infection (HR 10.85), history of alcohol abuse (HR 4.34) and successful antiviral treatment (HR 0.14). Of the 487 patients who were still alive at the end of follow-up, 49% did not undergo optimal conventional antiviral treatment. CONCLUSIONS After over 30 years of HCV infection, ESLD occurred in a significant proportion of patients with inherited bleeding disorders. HCC appears to be an increasing problem. There is a significant potential for both conventional and new antiviral treatment regimens to try and limit ESLD occurrence in the future.
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Affiliation(s)
| | - Michael Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Kathelijn Fischer
- Van Creveldkliniek, Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thynn Thynn Yee
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Lisa Kirk
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Karel Johannes van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David Patch
- Department of Hepatology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Dirk Posthouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Medical Microbiology and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
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49
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Matovina-Brko G, Ruzic M, Fabri M, Popovic L, Kolarov-Bjelobrk I, Trifunovic J, Petkovic D. Treatment of acute hepatitis C in breast cancer patient: a case report. J Chemother 2013; 26:180-3. [DOI: 10.1179/1973947813y.0000000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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50
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Sun CL, Kersey JH, Francisco L, Armenian SH, Baker KS, Weisdorf DJ, Forman SJ, Bhatia S. Burden of morbidity in 10+ year survivors of hematopoietic cell transplantation: report from the bone marrow transplantation survivor study. Biol Blood Marrow Transplant 2013; 19:1073-80. [PMID: 23583827 PMCID: PMC3691346 DOI: 10.1016/j.bbmt.2013.04.002] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/04/2013] [Indexed: 01/29/2023]
Abstract
Long-term morbidity after hematopoietic cell transplantation (HCT) is unknown. The risk of physical and psychological health in 324 patients who had survived 10 or more years after HCT and a sibling comparison group (n = 309) was evaluated. Using the Common Terminology Criteria for Adverse Events, the 15-year cumulative incidence of severe/life-threatening/fatal conditions was 41% (95% confidence interval, 34% to 48%). HCT survivors were 5.7 times as likely to develop a severe/life-threatening condition (P < .001) and 2.7 times as likely to report somatic distress (P < .001) compared with siblings. Compared with allogeneic HCT recipients with no chronic graft-versus-host disease (GVHD), those with active chronic GVHD were at a 1.8-fold higher risk of severe/life-threatening health conditions (P = .006) and a 4.5-fold higher risk of somatic distress (P = .04); allogeneic HCT recipients with resolved chronic GVHD were not at increased risk of morbidity compared with those with no chronic GVHD. Only 27% of the HCT survivors returned to the transplantation center for their cancer-related care. The burden of long-term physical and emotional morbidity borne by survivors remains substantial, even beyond 10 years after HCT; however, specialized health care is underused. Patients, families, and healthcare providers need to be made aware of the high burden, so they can plan for post-HCT care, even many years after HCT.
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Affiliation(s)
- Can-Lan Sun
- Department of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA
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