The Impact of HCV Viremia on the Tempo of Engraftment and the Incidence of Acute and Chronic Graft Versus Host Disease (GVHD) As Well As Sinusoidal Obstruction Syndrome (SOS): A Single Centre Experience of 332 Patients Following Allogeneic Peripheral Blood Stem Cells Transplantation (PBSCT)
Authors: Fahmy Omar , Fathy Gamal El Din M , Elhaddad Alaa M , Sultan Almetwaly M. , Ibrahim Shimaa , Bokhary Mahmoud , Elnahass Yasser , Talaat Mohamed , Abdelfattah Rafaat MS , Samra Mohamed A. , Mahmoud Hossam K 
Published: November 2019

Introduction: Numerous factors affect the outcome of Allogeneic Peripheral blood stem cells transplantation (PBSCs). In Egypt, roughly 15 million patients are currently suffering from Hepatitis C (HCV) viremia with 40,000 deaths each year.

Aim: To study the impact of HCV viremia on the tempo of engraftment and on incidence of acute and chronic graft versus host disease (GVHD) as well as sinusoidal obstruction syndrome (SOS).

Patients and methods: Between March 1997 and June 2014, 332 HCV seropositive patients with various hematological disorders were enrolled; 54 acute lymphoblastic leukemia (ALL), 131 acute myeloid leukemia (AML), 46 severe aplastic anemia (SAA), 29 B thalassemia major (B-TM), 22 chronic myeloid leukemia (CML) and 25 myelodysplastic syndrome (MDS) patients; all received allogeneic peripheral blood stem cells transplantation (PBSCT) at the BMT unit of Nasser Institute hospital for Research and Treatment, Cairo, Egypt .

Conditioning regimens using Fludarabine (FLU), Busalphan (BU), cyclophosphamide (CY), antithymocyte globulin (ATG), melphalane (MELPH) and total body irradiation (TBI) differed according to disease entity including (BU/CY, FLU/BU for AML and CML, , BU/CY/ATG for B-TM, TBI/CY for ALL, FLU/CY for SAA and FLU/MELPH). GVHD prophylaxis consisted of methotrexate (MTX) at days 1, 3, 6 & 11 plus Cyclosporin A (CSA) starting from day -1. Mycophenolate mofetil (MMF) was added to cases transplanted using reduced intensity conditioning (RIC).

Results: Neutrophil engraftment was reached at a median of 15, 14, 12, 16, 17, and 17 days for ALL, AML, SAA, B-TM, CML and MDS patients, respectively. Platelet engraftment was reached at a median of 11, 12, 13, 15, 22 and 11 days for ALL, AML, SAA, B-TM, CML and MDS patients, respectively.

The incidence of SOS was 2.7%, 2.2%, 2.1%, 3.4%, zero%, and zero % in ALL, AML, SAA, B-TM, CML and MDS patients, respectively. Acute GVHD grade 2-4 was reported in 6 ALL, 18 AML, 2 SAA, 3 BTM, 10 CML and 2 MDS patients while chronic GVHD was reported in 7 ALL, 16 AML, 2 SAA, 2 BTM, 3 CML, and 2 MDS patients. Event free survival (EFS) in all disease entities was 44.7% at 3 years & 44.3% at 5 years while overall survival (OS) was 55.9% at 3 years & 54.2 % at 5 years for all patients, respectively.

Conclusion: Analysis of 332 HCV positive patients subjected to PBSCT show that HCV does not affect platelet or neutrophil engraftment or the incidence of SOS. HCV viremia does not show a significant impact on the incidence of aGVHD and cGVHD or OS. However, a comparative study with a negative HCV patient's cohort is still ongoing.

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Disclosures

No relevant conflicts of interest to declare.