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Blood, 1 April 2004, Vol. 103, No. 7, pp. 2460-2466.
Prepublished online as a Blood First Edition Paper on December 18, 2003; DOI 10.1182/blood-2003-07-2565.
Submitted July 29, 2003
Accepted October 29, 2003
The epidemiology of chronic hepatitis C in survivors of childhood cancer
Sharon Castellino, Shelly Lensing, Caroline Riely, Shesh N Rai, Rene Davila, Randall T Hayden, Jackie Fleckenstein, Mark Levstik, Shari Taylor, Patrick J Dean, Sarah Kippenbrock, Jennifer Pope, Jeanne Carr, D K Strickland, and Melissa M Hudson*
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
Departments of Medicine and Pediatrics, University of Tennessee, Memphis, TN, USA
Department of Pathology, G I Pathology Partners, Memphis, TN, USA
Department of Pediatrics, East Tennessee State University, Johnson City, TN, USA
* Corresponding author; email: melissa.hudson{at}stjude.org.
Childhood cancer survivors transfused before 1992 are at risk for chronic hepatitis C (HCV) infection. In 1995, St. Jude Children's Research Hospital initiated an epidemiological study of childhood cancer survivors with transfusion-acquired HCV. Of the 148 survivors with HCV confirmed by second-generation enzyme immunoassay, 122 consented to participate in the study. Their current median age is 29 years (range, 9 to 47 years). At enrollment, PCR testing indicated chronic infection in 81.1%,and genotype 1 was the most common HCV genotype. Liver biopsy in 60 patients at a median of 12.4 years from the diagnosis of malignancy showed mild (28.8%) or moderate (35.6%) fibrosis; 13.6% had cirrhosis. Elevated body mass index was associated with histologic findings of increased steatosis (P=0.008). Antimetabolite chemotherapy exposure was associated with early progression of fibrosis. Significant quality-of-life deficits were observed in non-cirrhotic adult survivors compared to adult norms. Antiviral therapy resulted in clearance of infection in 17 (44%) of 38 patients to date. Six patients have died; one patient with decompensated cirrhosis died of variceal bleeding. Despite a young age at HCV infection, the progression of liver disease in childhood cancer survivors is comparable to that seen in adults.
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