Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Padova, Italy.
Pediatr Blood Cancer. 2010 Jul 15;55(1):108-12. doi: 10.1002/pbc.22438.
The aim of the study was to evaluate the clinical characteristics and the long-term outcome of chronic hepatitis C in a cohort of Caucasian children cured of pediatric malignancy.
The study population included 83 consecutive patients, referred to our Center with a diagnosis of leukemia/lymphoma (50) or solid tumors (33) between 1977 and 1989 and infected with hepatitis C virus (HCV) during chemotherapy.
At enrollment 77 subjects were HCV-RNA positive. After a median follow-up of 21 years (range 13-36), a sustained virological response (SVR) was obtained in 3 of 29 patients (10%) treated with interferon (IFN), in 1 of 3 patients (33%) treated with IFN and ribavirin, and in 5 of 11 patients (42%) treated with pegylated-IFN and ribavirin (P = 0.03). Forty-two patients remained untreated and only one (2.5%) cleared viremia. Four of 77 patients (5%) developed cirrhosis while other 4 patients died of causes not related to liver. At last follow-up, 72% of HCV-RNA positive patients had abnormal ALT.
In patients cured of pediatric malignancy chronic hepatitis C tends to run an indolent course during childhood and adolescence but more than 70% of treated and more than 80% of untreated cases children maintained HCV viremia. Moreover, after 2-3 decades of observation, 60% of HCV-RNA positive patients had abnormal ALT and 5% had developed cirrhosis. Among treated patients, IFN or pegylated-IFN and ribavirin obtained the higher rate of HCV-RNA clearance.
本研究旨在评估在一群治愈儿科恶性肿瘤的白种人儿童中，慢性丙型肝炎的临床特征和长期预后。
研究人群包括 83 例连续患者，他们于 1977 年至 1989 年间因白血病/淋巴瘤（50 例）或实体瘤（33 例）被诊断为癌症，并在化疗期间感染丙型肝炎病毒（HCV），随后被转诊至本中心。
在入组时，77 例患者 HCV-RNA 阳性。经过 21 年的中位随访（范围 13-36 年），29 例接受干扰素（IFN）治疗的患者中，有 3 例（10%）获得持续病毒学应答（SVR），3 例接受 IFN 和利巴韦林治疗的患者中，有 1 例（33%）获得 SVR，11 例接受聚乙二醇干扰素和利巴韦林治疗的患者中，有 5 例（42%）获得 SVR（P = 0.03）。42 例患者未接受治疗，仅有 1 例（2.5%）清除了病毒血症。77 例患者中有 4 例（5%）发展为肝硬化，另外 4 例患者死亡，但与肝脏无关。最后一次随访时，72%的 HCV-RNA 阳性患者丙氨酸氨基转移酶（ALT）异常。
在治愈儿科恶性肿瘤的患者中，慢性丙型肝炎在儿童和青少年时期倾向于呈惰性病程，但在接受治疗的患者中，超过 70%和未接受治疗的患者中，超过 80%的患者维持丙型肝炎病毒血症。此外，经过 2-3 十年的观察，60%的 HCV-RNA 阳性患者丙氨酸氨基转移酶（ALT）异常，5%的患者发展为肝硬化。在接受治疗的患者中，IFN 或聚乙二醇干扰素和利巴韦林获得了更高的 HCV-RNA 清除率。
