ALPHA-INTERFERON TREATMENT OF CHRONIC HEPATITIS-C AFTER BONE-MARROW TRANSPLANTATION FOR HOMOZYGOUS BETA-THALASSEMIA

No experience has been reported to date in treating chronic hepatitis C virus (HCV) infection with interferon (IFN) therapy after BMT, mainl y due to concerns related to the impact of an immunomodulatory drug in patients who are immunologic and haematologic chimeras, However, chro nic inflammatory activity related to HCV infection results in a chroni c fibrogenous mechanism potentially leading to liver cirrhosis and hep atocellular carcinoma. Moreover, patients transplanted for P-thalassem ia could be at greater risk because of concomitant iron overload and p re-existing fibrous liver damage, Eleven patients with serological, bi ochemical, histological and molecular biological evidence of HCV infec tion were included in the study and treated for 6-12 months with recom binant IFN 24-65 months following BMT, The serum alanine aminotransfer ase (ALT) was persistently elevated (range 85-1242 U/l; mean 416) for at least 1 year prior to IFN treatment, Ten patients completed the pro tocol; five were considered as responders to treatment, In these five patients the liver histology showed an overall reduction of inflammati on and necrosis: histological inflammatory activity improved from chro nic active hepatitis (CAH) to chronic persistent hepatitis (three pati ents) or minimal residual inflammatory activity (two patients), The Kn odell total activity score varied from 5.4 (range 3-9) to 1.4 (range 1 -2; P = 0.05), All responding patients revealed negativization of seru m HCV-RNA, that has been persistent in four (follow-up 1-3 years), ALT level fell to 15-80 U/l (mean 52; P = 0.0027), No major complications occurred during the therapy and no influence on marrow engraftment pa rameters were noted. We conclude that IFN therapy does not adversely i nterfere with engraftment and that it is a feasible therapy for treatm ent of chronic hepatitis C virus after BMT.