Interferon-alpha and ribavirin in treating children and young adults with chronic hepatitis C after malignancy

Objective. Chronic hepatitis C is a major long-term problem for children wh o survive cancer. Interferon (IFN)-alpha has been shown to be effective in treating patients with chronic hepatitis C; however, the rate of sustained response is low. Combining IFN-alpha and ribavirin (RBV) has been shown to significantly improve the response in adult patients with chronic hepatitis C. The aim of this pilot study was to evaluate the efficacy and safety of a combined virostatic treatment with IFN-alpha and RBV in a small cohort of children and adolescents with chronic hepatitis C and previous malignancy. Methods. Twelve patients with a history of a hematooncologic disease (media n follow-up: 13.5 years; range: 7-14.7 years) and chronic hepatitis C were treated with recombinant IFN-alpha-2a (6 megaunits/m(2) body surface area, 3 times a week, subcutaneously) combined with RBV (15 mg/kg body weight/day , orally) for 12 months. They were tested monthly for blood counts and live r function, and for serum virus concentrations (hepatitis C virus RNA by po lymerase chain reaction) every 3 months. Results. At the end of the treatment, hepatitis C virus RNA could not be de tected in the serum of 8 of the 12 patients; 2 of these patients relapsed s oon after therapy withdrawal, whereas 6 patients maintained in sustained vi rologic and biochemical remission (follow-up: 12 months). Treatment-induced toxicity was moderate and reversible with influenza-like symptoms and a de crease in blood counts in all 12 patients, alopecia in 5 of the 12, hemolys is in 4 of the 12, and weight loss of >10% in 2 of the 12. Conclusions. As demonstrated in adults with chronic hepatitis C, treatment with IFN-alpha and RBV also seems to be an effective and safe therapeutic o ption for children and adolescents with chronic hepatitis C after malignanc y.