POSTTRANSFUSION HEPATITIS AFTER INDUCTION CHEMOTHERAPY IN ACUTE NONLYMPHOBLASTIC LEUKEMIA - IMPLICATIONS FOR LONG-TERM MANAGEMENT AND OUTCOME

Background: The purpose of this study was to evaluate 1) the incidence of hepatitis and its influence on the clinical management of and outc ome in acute nonlymphoblastic leukemia (ANLL) patients in first comple te remission and 2) the impact of routine hepatitis C virus screening on the incidence of hepatitis in these patients. Study Design and Meth ods: Clinical and blood bank charts were reviewed for 65 consecutive A NLL patients between 1985 and 1993 who achieved complete remission aft er a course of daunomycin and cytarabine (cytarabine: 200 mg/m(2)/day x 7 days in continuous infusion; daunomycin: 60 mg/m(2)/day for the fi rst 3 days of the 7, as a bolus). Results: Only 43 percent of patients who developed hepatitis completed the scheduled therapy. Hepatitis di d not decrease the probability of relapse (66 +/- 9% vs. 66 +/- 11%), but patients with changes in planned treatment, due to hepatitis or ot her causes, tended to have a higher relapse rate than patients without changes in consolidation therapy (56.5% vs, 40.4%; p = 0.10). This di d not result in a decrease in disease-free survival, however, because of the higher number of treatment-related deaths in the patients witho ut hepatitis (who completed the therapy). Over the period from 1985 th rough 1989, the and month actuarial probability of developing hepatiti s was 42 percent. However, since 1989, when hepatitis C screening of b lood donors was implemented, the incidence was reduced to 12.5 percent (p<0.05), in spite of greater transfusion support (172 +/- 46 vs. 89 +/- 53, p<0.01). No new cases of hepatitis were observed after the int roduction of second-generation hepatitis C virus assays. Conclusion: H epatitis precludes the use of consolidation therapy in about half of A N LL patients, resulting, in the experience described here, in a trend toward a higher rate of relapse. Hepatitis C virus screening of blood components reduces the incidence of hepatitis in ANLL patients.