Hepatitis C infection among survivors of childhood cancer

Preliminary reports have suggested that survivors of childhood cancer and a plastic anemia who are infected with the hepatitis C virus (HCV) have a low risk for progression to significant liver disease. Among our surviving pat ients who were transfused between 1961 and March 1992, 77 (6.6% of survivin g patients tested thus far) have evidence of HCV infection, whereas 4 survi ving patients who were transfused after March 1992 are HCV-infected. One pa tient chronically infected with HCV died of liver failure, and 2 patients d ied of hepatocellular carcinoma. To characterize the risk for these and oth er complications, 65 patients are enrolled in a longitudinal study of HCV i nfection, of whom 58 (89.2%) had circulating HCV RNA at the time of protoco l enrollment, with genotypes 1A and 1B most commonly isolated. Most enrolle d patients have few or no symptoms, carry out normal activities, and have n ormal 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%) hav e fibrosis, and 3 (9%) have cirrhosis. These preliminary data suggest that though most survivors of childhood cancer who are infected with HCV are cli nically well, some are at risk for clinically significant liver disease. Id entification of other HCV-infected patients and prospective monitoring of t his cohort are ongoing to determine the risk for, and to identify factors a ssociated with the progression of, liver disease. (C) 2000 by The American Society of Hematology.