الفهرس 
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Abstract
It is estimated that over 170 million people suffer from HCV infection worldwide. The prevalence of HCV infection in patients with cancer ranges from 1.5% to 32.0%. chronic HCV infection in patients with cancer causes significant additional morbidity and mortality and can interfere with cancer treatment. Over the past two decades, considerable evidence has accumu¬lated with regard to the association between HCV and several hematologic malignancies, most notably B-cell NHL.
The natural course of HCV infection can be altered by cancer treatment. Previous studies have reported a high proportion of chemotherapy discontinuation among patients with cancer with HCV infection and hepatic flares. Damaged liver function after chemotherapy in HCV-infected patients may be related to immunosuppression and HCV reactivation. However, the mechanism of liver injury is still unclear. Poor outcomes may be attributed to hepatotoxicity in patients with underlying hepatitis C or worsening of hepatitis C because of increased HCV replication.
Hematopoietic stem cell transplantation (HCT) improves outcomes in patients with hematologic malignancies. However, the hepatic, extrahepatic, and oncologic outcomes of HCV infection in HCT recipients have yet to be systematically characterized. The occurrence of infection with HCV in patients undergoing HSCT poses several clinical problems, as it can jeopardize the ultimate prognosis, owing to the possibility of progression to fulminant hepatic failure and also the possible evolution to chronic active hepatitis, liver cirrhosis, or hepatocellular carcinoma.
We evaluated the clinical outcome of patients with hematological malignancies and HCV infection by studying the impact of autologous bone marrow transplantation and intensive chemotherapy on viral load kinetics of HCV infected patients and correlate it with the clinical outcome. The study was carried out on 30 patients attending El-Maadi Armed Forces Medical Compound, Cairo, Egypt to receive intensive chemotherapy or autologous BMT. We assessed two parameters; alanine aminotransferase (ALT), and HCV RNA by PCR, both before and after exposure to chemotherapy or HSCT.
In our study, 86.6% of patients in the chemotherapy arm showed elevation in the ALT level post-chemotherapy as compared to pre-chemotherapy level. However, only two patients (13.3%) in this group developed hepatitis (defined as a 3-fold increase in the ALT level over baseline). Similarly, in the HSCT arm, 93.3% of patients showed elevation in the ALT level post- HSCT as compared to pre- HSCT level. No patients in this group developed hepatitis; however, two patients (13.3%) experienced doubling of ALT level.
In our study, 60% of patients in the chemotherapy arm showed reduction in the HCV-RNA level post-chemotherapy as compared to pre-chemotherapy level. Twenty percent of the patients showed no change in HCV RNA level. Enhanced HCV replication (rise in HCV-RNA level) occurred in 20% of patients. In the HSCT arm, 80% of patients showed reduction in the HCV-RNA level post- HSCT as compared to pre- HSCT level. Twenty percent of the patients showed no change in HCV RNA level pre- & post- HSCT.