title: Impact of hepatitis C virus seropositivity on survival after allogeneic hematopoietic stem cell transplantation for hematologic malignancies.
abstract: BACKGROUND
  Because hepatitis C virus infection causes hepatic and immunological dysfunction, we hypothesized that seropositivity for this virus could be associated with increased non-relapse mortality after allogeneic hematopoietic stem cell transplantation.
  
  
  METHODS
  We performed a case-control study of the outcomes of patients who were hepatitis C virus seropositive at the time of allogeneic hematopoietic stem cell transplantation (N=31). Patients positive for hepatitis C virus were considered candidates for stem cell transplantation only if they had no significant evidence of hepatic dysfunction. Matched controls (N=31) were seronegative for viral hepatitides and were paired according to age, diagnosis, disease stage, conditioning regimen and donor type. We also compared the hepatitis C virus seropositive patients to all seronegative patients (all controls, N=1800) transplanted during the same period, to adjust for other confounding effects.
  
  
  RESULTS
  The median age of the seropositive patients was 49 (range 26-72); 15 had acute myeloid leukemia/myelodysplastic syndrome, 6 had chronic myeloid leukemia/myeloproliferative disease, 6 non-Hodgkin's lymphoma, 2 myeloma, 1 acute lymphocytic leukemia and 1 Hodgkin's lymphoma; 61% had poor risk disease; 68% had related donors; 68% received reduced intensity conditioning; 7 patients had mildly abnormal alanine transaminase levels (all less than three times the upper limit of normal) and 1 patient had minimally elevated bilirubin. These characteristics were similar to those of the matched control group. Median overall survival was 3, 18 and 20 months, and 1-year survival was 29%, 56% and 56%, in the hepatitis C virus, matched and all controls groups, respectively (hazard ratio for death 3.1, 95% confidence interval 1.9-5.6, p<0.001 in multivariate analysis). Non-relapse mortality at 1 year was 43%, 24% and 23%, respectively (hazard ratio 3.3, 95% confidence interval 1.8-7.1, p<0.01). Disease progression and graft-versus-host disease rates were comparable.
  
  
  CONCLUSIONS
  Hepatitis C virus seropositivity is a significant risk factor for non-relapse mortality after allogeneic hematopoietic stem cell transplantation even in patients with normal or minimally abnormal liver function tests.
authors.affiliation: Department of Stem Cell, Transplantation and Cellular Therapy, The University of Texas M.D., Anderson Cancer Center 1515 Holcombe Blvd., Unit 423, Houston, TX 77030, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Ramos
authors.forename: Rima M
authors.initials: RM
authors.lastname: Saliba
authors.forename: Leandro
authors.initials: L
authors.lastname: de Pádua
authors.forename: Ola
authors.initials: O
authors.lastname: Khorshid
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Poliana A
authors.initials: PA
authors.lastname: Patah
authors.forename: Chitra M
authors.initials: CM
authors.lastname: Hosing
authors.forename: Uday R
authors.initials: UR
authors.lastname: Popat
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Issa F
authors.initials: IF
authors.lastname: Khouri
authors.forename: Yago L
authors.initials: YL
authors.lastname: Nieto
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D016174:Hepacivirus; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome