Department of Hematology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
Bone Marrow Transplant. 2012 Sep;47(9):1217-21. doi: 10.1038/bmt.2011.238. Epub 2011 Dec 12.
This prospective study was initiated in 1993 with the aim to study late effects and responses to antiviral therapy in a cohort of hepatitis C virus (HCV)-infected patients. A total of 195 patients were included from 12 centers. In all, 134 patients had undergone allogeneic and 61 autologous hematopoietic SCT (HSCT). The median follow-up from HSCT is currently 16.8 years and the maximum 27.2 years. Overall 33 of 195 patients have died of which 6 died from liver complications. The survival probability was 81.6% and the cumulative incidence for death in liver complications was 6.1% at 20 years after HSCT. The cumulative incidence of severe liver complications (death from liver failure, cirrhosis and liver transplantation) was 11.7% at 20 years after HSCT. In all, 85 patients have been treated with IFN; 42 in combination with ribavirin. The sustained response rate was 40%. The rates of severe side effects were comparable to other patient populations and no patient developed significant exacerbations of GVHD. Patients receiving antiviral therapy had a trend toward a decreased risk of severe liver complications (odds ratio=0.33; P=0.058). HCV infection is associated with morbidity and mortality in long-term survivors after HSCT. Antiviral therapy can be given safely and might reduce the risk for severe complications.
本前瞻性研究始于 1993 年，旨在研究丙型肝炎病毒 (HCV) 感染患者队列的晚期效应和抗病毒治疗反应。共有来自 12 个中心的 195 名患者入选。共有 134 名患者接受了同种异体和 61 名自体造血干细胞移植 (HSCT)。从 HSCT 开始的中位随访时间目前为 16.8 年，最长为 27.2 年。共有 195 名患者中有 33 名死亡，其中 6 名死于肝脏并发症。生存率为 81.6%，HSCT 后 20 年肝脏并发症死亡的累积发生率为 6.1%。HSCT 后 20 年严重肝脏并发症（肝衰竭、肝硬化和肝移植死亡）的累积发生率为 11.7%。共有 85 名患者接受 IFN 治疗；42 名患者联合利巴韦林治疗。持续缓解率为 40%。严重副作用的发生率与其他患者群体相当，没有患者出现明显的 GVHD 恶化。接受抗病毒治疗的患者严重肝脏并发症风险呈下降趋势（比值比=0.33；P=0.058）。HCV 感染与 HSCT 后长期幸存者的发病率和死亡率相关。抗病毒治疗可以安全进行，并可能降低严重并发症的风险。
