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Blood, Vol. 95 No. 10 (May 15), 2000:
pp. 3065-3070
Hepatitis C infection among survivors of childhood cancer
Donald K. Strickland,
Caroline A. Riely,
Christian C. Patrick,
Dana Jones-Wallace,
James M. Boyett,
Bradford Waters,
Jaquelyn Fitch Fleckenstein,
Patrick J. Dean,
Rene Davila,
Tony
E. Caver, and
Melissa M. Hudson
From the Departments of Hematology-Oncology, Infectious Diseases,
Pathology and Laboratory Medicine, and Biostatistics, St. Jude
Children's Research Hospital; the Departments of Medicine and
Pediatrics, University of Tennessee-Memphis; and the G. I. Pathology
Partners, Memphis, TN.
Preliminary reports have suggested that survivors of childhood
cancer and aplastic anemia who are infected with the hepatitis C virus
(HCV) have a low risk for progression to significant liver disease.
Among our surviving patients who were transfused between 1961 and March
1992, 77 (6.6% of surviving patients tested thus far) have evidence of
HCV infection, whereas 4 surviving patients who were transfused after
March 1992 are HCV-infected. One patient chronically infected with HCV
died of liver failure, and 2 patients died of hepatocellular carcinoma.
To characterize the risk for these and other complications, 65 patients
are enrolled in a longitudinal study of HCV infection, of whom 58 (89.2%) had circulating HCV RNA at the time of protocol enrollment,
with genotypes 1A and 1B most commonly isolated. Most enrolled patients
have few or no symptoms, carry out normal activities, and have normal
liver function. To date, 35 patients have undergone liver biopsy for abnormal liver function since the diagnosis of primary malignancy; central pathology review shows 28 (80%) have chronic active hepatitis, 25 (71%) have fibrosis, and 3 (9%) have cirrhosis. These preliminary data suggest that though most survivors of childhood cancer who are
infected with HCV are clinically well, some are at risk for clinically
significant liver disease. Identification of other HCV-infected
patients and prospective monitoring of this cohort are ongoing to
determine the risk for, and to identify factors associated with the
progression of, liver disease.
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