Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, Texas; Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Transplant Cell Ther. 2022 Nov;28(11):788.e1-788.e5. doi: 10.1016/j.jtct.2022.08.020. Epub 2022 Aug 27.
Hepatitis E virus (HEV) infection in immunocompetent patients can lead to chronic hepatitis and liver failure. However, the burden of HEV infection in cancer patients is largely unknown. We studied the characteristics of HEV infection in patients at a tertiary care cancer center in the United States. This retrospective study included adult cancer patients with HEV infection diagnosed between September 2011 to September 2021. A total of 405 patients were tested for HEV, and 63 (16%) had detectable HEV IgG. Thirty-three patients (52%) were male, 43 were born in America (68%), 46 (73%) were screened for HEV because of pre-existing liver conditions, and 22 (35%) had hematological malignancies. Only 2 patients had detectable HEV RNA. The first patient had myelodysplastic syndrome and underwent allogeneic stem cell transplantation (HSCT). He developed elevated liver enzymes with HEV RNA 14,000 IU/mL (4.2 log IU/mL) 13 months after HSCT. After reducing immunosuppression, his HEV viremia resolved. The second patient had diffuse large B-cell lymphoma and underwent anti-CD19 chimeric antigen receptor (CAR) T-cell therapy. She had elevated liver enzymes with HEV RNA 4,560,000 IU/mL (6.7 log IU/mL) 12 months after CAR T-cell therapy. She developed chronic HEV infection, and ribavirin treatment failed. Now she is being considered for salvage treatment with peginterferon alfa-2a and ribavirin. This study is the first report of chronic HEV infection in patients who received CAR T-cell therapy. HEV infection in cancer patients appears to be at least as common as in the general population. Cancer patients with hematologic malignancies may be at risk for HEV viremia and chronic infection refractory to antiviral treatment.
戊型肝炎病毒 (HEV) 感染在免疫功能正常的患者中可导致慢性肝炎和肝功能衰竭。然而，癌症患者中 HEV 感染的负担在很大程度上尚不清楚。我们研究了美国一家三级癌症中心的患者中 HEV 感染的特征。这项回顾性研究纳入了 2011 年 9 月至 2021 年 9 月期间被诊断为 HEV 感染的成年癌症患者。共有 405 名患者接受了 HEV 检测，其中 63 名（16%）的 HEV IgG 可检测到。33 名患者（52%）为男性，43 名患者（68%）出生于美国，46 名患者（73%）因存在先前的肝脏疾病而筛查 HEV，22 名患者（35%）患有血液系统恶性肿瘤。仅 2 名患者的 HEV RNA 可检测到。第一例患者患有骨髓增生异常综合征，并接受了异基因造血干细胞移植（HSCT）。在 HSCT 后 13 个月，他的肝功能酶升高，HEV RNA 为 14,000 IU/mL（4.2 log IU/mL）。减少免疫抑制后，他的 HEV 血症得到了缓解。第二例患者患有弥漫性大 B 细胞淋巴瘤，并接受了抗 CD19 嵌合抗原受体（CAR）T 细胞治疗。在 CAR T 细胞治疗后 12 个月，她的肝功能酶升高，HEV RNA 为 4,560,000 IU/mL（6.7 log IU/mL）。她发展为慢性 HEV 感染，且利巴韦林治疗失败。现在她正在考虑使用聚乙二醇干扰素 alfa-2a 和利巴韦林进行挽救治疗。这项研究首次报道了接受 CAR T 细胞治疗的患者中发生的慢性 HEV 感染。癌症患者中 HEV 感染的发生率似乎至少与普通人群一样高。患有血液系统恶性肿瘤的癌症患者可能有发生 HEV 病毒血症和对抗病毒治疗产生耐药的慢性感染的风险。
