Abstract
The aim of the study was to evaluate the rate of hepatitis B and C virus infection and emphasize the importance of hepatitis B virus (HBV) vaccination in leukemic children. One hundred and sixty children who were treated for acute lymphoblastic leukemia (ALL) at Hacettepe University Faculty of Medicine, Pediatric Hematology Unit were included in the study. They were 71 (44.4%) girls and 89 (55.6%) boys with a mean age of 6.45 +/- 3.87 years. Of these 160 children, 22 (13.8%) were anti-HBs-positive and 138 (86.2%) were anti-HBs-negative at the diagnosis of ALL. Among the 138 anti-HBs-negative children, 67 (41.9%) were vaccinated for HBV during maintenance chemotherapy, and 71 (44.3%) could not be vaccinated. Two (2.9%) vaccinated and 22 (30.9%) unvaccinated children developed HBV infection during the follow-up period (P < 0.001). Among 160 children treated for ALL, 24 (15.0%) had HBV, three (1.9%) had hepatitis C virus (HCV) infections, and 29 (18.1%) had toxic hepatitis. The majority of patients with HBV or HCV infections had high risk (HR) protocol, whereas most of the patients with toxic hepatitis had low risk (LR) protocol, especially St Jude Total XIII LR protocol. Viral hepatitis and toxic hepatitis were observed more commonly in the HR and LR group, respectively, of ALL patients. This could be explained by intensive chemotherapy and more heavy blood product administration in the HR group and the chemotherapeutic agents of methotrexate and 6-mercaptopurine, basic drugs used in the LR group. In respect to protection from these complications, periodical liver function tests, serological tests for HBV and HCV, and vaccination for HBV should be performed for all children with ALL.
Highlights
HEPATITIS WITH ELEVATION of aminotransferase levels is common during the treatment of children with acute lymphoblastic leukemia (ALL)
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are more common in children with ALL than in the general population because
Two children (2/67, 2.9%) who were vaccinated during maintenance chemotherapy and 22 (22/71, 30.9%) unvaccinated children developed HBV infection (P < 0.001)
Summary
HEPATITIS WITH ELEVATION of aminotransferase levels is common during the treatment of children with acute lymphoblastic leukemia (ALL). Toxic hepatitis may result from chemotherapeutic agents, especially methotrexate (Mtx) and 6-Merkaptopurine (6-MP). Hepatitis B and C virus infections, occasionally leukemic infiltration, bacterial infections and antibiotics used during febril neutropenia periods, are responsible for the elevation of hepatic transaminases. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are more common in children with ALL than in the general population because of transfusions given during the treatment and the immunosuppressive effect of the chemotherapy.[1,2,3] The aim of this study was to evaluate the hepatitis B or C virus infections of children treated for ALL in our center and to emphasize the importance of HBV vaccination in leukemic children
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