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Blood, Vol. 93 No. 11 (June 1), 1999:
pp. 3672-3677
Chronic Hepatitis C Virus Infections in Leukemia Survivors:
Prevalence, Viral Load, and Severity of Liver Disease
Ian M. Paul,
Jeffrey Sanders,
Francesca Ruggiero,
Thomas Andrews,
David Ungar, and
M. Elaine Eyster
From the Division of Hematology/Oncology, Department of Medicine and
the Departments of Pathology and Pediatrics, Pennsylvania State
University College of Medicine, Hershey, PA.
The natural history of chronic hepatitis C (HCV) infections in
long-term leukemia survivors has not been well characterized. We
studied the prevalence of HCV infections, measured HCV RNA levels, and
evaluated the severity of liver disease in patients with leukemia who
achieved long-term remissions after intensive chemotherapy or bone
marrow transplantation (BMT). HCV antibody tests were performed by the
enzyme-linked immunosorbent assay (ELISA) and positive tests confirmed
by the recombinant immunoblot assay (RIBA). HCV RNA levels were
measured by the branched DNA (bDNA) assay. Seventy-five leukemia
survivors with 25 or more blood donor exposures were identified. Nine
(12%) were anti-HCV positive. All were infected before 1992 when
second generation HCV screening tests were implemented. Mean HCV RNA
levels were 10.3 ×106 eq/mL versus 3.2 × 106 eq/mL (P = .056) in a control group of 20 anti-HCV positive immunocompetent individuals of comparable age who
were infected twice as long (17.8 ± 6.5 years v 9.0 ± 4.4 years in leukemia survivors, P = .001). Liver biopsies were
performed on six of the nine anti-HCV positive leukemia survivors. All
showed at least moderate portal inflammation and half had evidence of
bridging fibrosis. We conclude that viral loads in anti-HCV positive
leukemia survivors are markedly higher than in immunocompetent
controls. Our results suggest that long-term leukemia survivors with
chronic HCV may have more rapidly progressive liver disease than has
been previously recognized.
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