Success With DAA for Hepatitis C Prior to Stem Cell Transplant

The results of 2 reported case studies of children with chronic hepatitis C infection indicated that viral eradication can be achieved and maintained until full immune recovery throughout allogeneic hematopoietic stem cell transplantation, if the patients receive full courses of direct-acting antivirals (DAAs) immediately before undergoing the procedure, according to a study published in the Journal of Viral Hepatitis.

American Society for Blood and Marrow Transplantation guidelines currently recommend that hematopoietic stem cell transplantation candidates with hepatitis C start and complete DAA therapy prior to undergoing stem cell transplantation. Time constraints and limiting comorbidities, treatments, and conditions can often make this approach unfeasible, but data on antiviral treatment safety and efficacy and the late effects of hepatitis C infection in hematopoietic stem cell transplantation patients are unknown.

This article reports on the cases of 2 children with chronic hepatitis C infection. Patient 1 successfully completed 12 weeks sofosbuvir/ribavirin therapy 6 days prior to undergoing hematopoietic stem cell transplantation for bone marrow failure. Post-transplant, the patient was given cyclosporine A, methotrexate, valaciclovir, and liposomal amphotericin B.

Patient 2 successfully completed sofosbuvir/simeprevir therapy shortly before hematopoietic stem cell transplantation for acute leukemia, and post-transplant was also given cyclosporine A, methotrexate, valaciclovir, and posaconazole.

Both patients maintained sustained virologic response throughout treatment, tolerated their interferon-free DAA regimens well, and showed full immune recovery. At the last post-transplant follow-up (790 days post-transplant for Patient 1 and 733 days for Patient 2), both patients continued to show no evidence of hepatitis C replication and no detectable anti-HCV IgG antibodies.

Study investigators concluded that “[w]hile the two pediatric cases presented here provide support for the principal feasibility, safety, and antiviral efficacy of treatment with the novel regimens prior to transplantation, more systematic studies are clearly needed to fully assess timing, safety and efficacy of DAAs and the long-term outcomes in allogeneic [hematopoietic stem cell transplantation] recipients with chronic HCV infection.”

Reference

Rauwolf K, Herbrüggen H, Zöllner S, et al. Durable control of hepatitis C through interferon-free antiviral combination therapy immediately prior to allogeneic hematopoietic stem cell transplantation [published online December 5, 2018]. J Viral Hepat. doi: 10.1111/jvh.13046