title: Feasibility of pegylated interferon and ribavirin in hepatitis C-related cirrhosis with neutropenia or thrombocytopenia.
abstract: OBJECTIVE
  To investigate the feasibility of pegylated interferon plus ribavirin treatment in cirrhotic patients who presented with, or developed while on-treatment, platelet counts ≤ 80,000/μL and/or neutrophil counts ≤ 1,500/μL.
  
  
  METHODS
  A retrospective analysis of prospectively gathered data on 123 cirrhotic patients treated with pegylated interferon and ribavirin. Adverse effects and haematological changes were monitored: bleeding and infectious events were registered and related to platelet and absolute neutrophil counts.
  
  
  RESULTS
  Among the 58 patients (47.2%) with nadir platelets ≤ 50,000/μL during therapy, 6 (10.3%) experienced a bleeding episode; of the remaining 65 patients with platelets constantly >50,000/μL, 3 (4.6%) bled. Of the 11 bleedings, 3 manifested during an infection, while patients had platelets >50,000/μL. Nadir neutrophils ≤ 750/μL occurred in 45 patients (38.2%) during treatment, and 14 of them (29.8%) had an infectious event. Infections were also documented in 18 of the 76 patients (23.7%) with neutrophils constantly >750/μL.
  
  
  CONCLUSIONS
  The study reveals the feasibility of treating cirrhotic patients with cytopenia with pegylated interferon and ribavirin, as bleeding or infectious events under therapy were unrelated to platelet and neutrophil counts. Withdrawal of therapy or variations in the pre-assigned dosages of either pegylated interferon or ribavirin owing to abnormally low haematological parameters seems to no longer be tenable.
authors.affiliation: Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy. Electronic address: an.iacobellis@libero.it.
authors.forename: Angelo
authors.initials: A
authors.lastname: Iacobellis
authors.affiliation: Division of Gastroenterology, De Bellis Hospital, IRCCS, Castellana Grotte 70013, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Cozzolongo
authors.affiliation: Division of Internal Medicine, General Hospital, Canosa 76012, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Minerva
authors.affiliation: Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Valvano
authors.affiliation: Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
authors.forename: Grazia Anna
authors.initials: GA
authors.lastname: Niro
authors.affiliation: Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
authors.forename: Rosanna
authors.initials: R
authors.lastname: Fontana
authors.affiliation: Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
authors.forename: Orazio
authors.initials: O
authors.lastname: Palmieri
authors.affiliation: Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ippolito
authors.affiliation: Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, IRCCS, San Giovanni Rotondo 71013, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Andriulli
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004844:Epistaxis / Q000097:blood / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000097:blood* / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood* / Q000209:etiology; D005884:Gingival Hemorrhage / Q000097:blood / Q000209:etiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007239:Infections / Q000097:blood / Q000209:etiology; D016898:Interferon-alpha / Q000009:adverse effects*; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000821:virology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000097:blood* / Q000139:chemically induced; D009504:Neutrophils; D010976:Platelet Count; D011092:Polyethylene Glycols / Q000009:adverse effects*; D011994:Recombinant Proteins / Q000009:adverse effects; D012189:Retrospective Studies; D012254:Ribavirin / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000097:blood* / Q000821:virology
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: Antiviral treatment; Bleeding; HCV; Infections; Liver cirrhosis; Neutrophils; Platelets