Outcomes and Survival in Hepatitis C Virus Seropositive Lymphoma and Myeloma Patients After Autologous Stem Cell Transplantation

Abstract

Introduction: Hepatitis C virus (HCV) seropositive patients who undergo autologous hematopoietic stem cell transplantation (HSCT) are at risk of HCV acute exacerbation (AE). Furthermore impact of high dose chemotherapy in patients who have hepatitis C is unknown. We sought to determine the risk factors for AE and the impact of HCV seropositivity on survival post-autologous HSCT. Methods: We retrospectively reviewed the medical records of all 64 HCV seropositive patients who had undergone autologous HSCT at our institution. COX regression model was used to evaluate the predictive risk factors for AE. Results: Twenty (32%) of the 64 patients had AE, defined as a 3-fold or greater increase in serum alanine aminotransferase level (ALT) from the pre-transplant value. Age above 60 years was found to be a risk factor for post-transplant AE (Figure 1). The occurrence of AE (analyzed as time-dependent variable) had no impact on the overall survival of patients who had undergone autologous HSCT. The overall and progression-free survival rates for chemosensitive lymphoma patients 2 years after autologous HSCT were 64% (range 41-80) and 47% (range 27-64), respectively. Median overall and progression-free survival durations in myeloma patients were 54 and 22 months, respectively.Figure 1: Cumulative incidence of acute exacerbation (AE) for all patients in the study and for the two age groups >60 years and ≤60 years.Conclusion: Our results suggest that the survival post autologous HSCT is not impacted by either the development of AE or the pre-transplant HCV seropositivity, as the survival of HCV seropositive patients post-transplant is similar to the survival of non-HCV seropositive historical controls. Hence, our study implies that HCV seropositivity is not a contraindication for autologous transplant.