Management of HCV-Infection in Pediatric Patients Undergoing HCT: A Single-Center Experience

• Published in: Blood 2024-11, Vol.144 (Supplement 1), p.7381-7381
• Main Authors: Pagano, Gennaro, Rossitti, Emanuela, Cacace, Fabiana, Caprioli, Valeria, D'Amico, Maria Rosaria, De Simone, Giuseppina, Sabbatino, Maria Simona, Wierda, William G., Tambaro, Francesco Paolo Paolo
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2024-200706

Background Management of pediatric patients with active hepatitis C virus (HCV) infection undergoing hematopoietic stem cell transplantation (HSCT) is challenging. The introduction of direct-acting antiviral agents (DAAs) has changed the approach to HCV treatment in all settings, including in immunocompromised patients. DAAs offer significant advantages over interferon, which is associated with adverse events such as myelosuppression. While there is a large amount of data on efficacy and tolerability of DAAs in the general population and in some immunocompromised patient populations, few studies have explored their use and outcomes in pediatric patients undergoing HSCT. There is no consensus regarding optimal timing to start DAAs in HSCT recipients, whether treating HCV infection before HSCTor after discontinuation of immunosuppression for GvHD prevention. Materials and Methods We report outcomes for 5 pediatric patients referred to our center from South America to receive HSCT for hematological diseases who had active HCV infection.Three patients were male. Median age was 4 years (2-13).HCV genotypes were: 1a, 3a and 1b for 2, 2 and 1 patient, respectively. The median HCV-RNA 110,139 IU/mL (9,703-1,250,100) before treatment. Three patients developed moderate (5-10 x normal value) elevated liver transaminases, 1 patient had mildly elevated liver transaminases (2x normal value) while 1 patient had normal liver enzymes. No patients developed liver fibrosis and all were class A Child-Pugh. Diagnosis was acute lymphoblastic leukemia for 3 patients, T-cell non-Hodgkin lymphoma for 1 and severe aplastic anemia for 1 patient. Donor was matched unrelated donor (MUD) and haploidentical donor (haplo) for 3 and 2 patients, respectively. Stem cell source was PBSC for 3 (1haplo - 2 MUD) and BM for 2 patients (1haplo -1 MUD), respectively. Four patients received myeloablative conditioning consisting of TBI + etoposide and busulfan + cyclophosphamide + thiotepa for 3 and 1 patient, respectively. One patient received a reduced-intensity conditioning regimen consisting of fludarabine + cyclophosphamide. GvHD prophylaxis was obtained with: ATG+CsA + MMF,CsA + ATG, CsA + MMF + post-transplant Cy for 3, 1 and 1 patients, respectively. DAAs were started after discontinuation of immunosuppressive therapy, for 4/5 patients.The combination of drugs used was: glecaprevir + pibrentasvir (2 patients), sofosbuvir + velpatasvir and ledipasvir + sofosbuvir. One patient was not treated