Current Treatment of HCV Infection After HSCT

Introduction:

According to previous EBMT studies, approximately 6% of HSCT recipients were HCV-positive (Locasciulli et al. Transplantation 1999). Despite the fact that HSCT recipients with chronic HCV infection are prone to HCV-morbidity (end stage liver disease, hepatocellular carcinoma, the need for liver transplant), only about half (44% and 61%) of long term survivors of HSCT were offered specific treatment (Ljungman et al. BMT 2012; Peffault de Latour et al. BMT 2005). The median time from HSCT to treatment was long and the efficacy was far from satisfactory (approximately 50%) (Ljungman et al. BMT 2012). Since 2011 novel oral directly acting antiviral agents (DAA) have been developed and marketed. DAAs offer the advantage of higher efficacy, shorter duration and reduced treatment toxicity; together with the possibility of exclusively oral, interferon- or interferon/ribavirin-free regimens.

Short description of the study:

The availability of novel therapies with DAAs might prompt clinicians caring for HSCT recipients with HCV infection to prescribe the treatment more frequently and possibly earlier after HSCT. Since numerous possible therapeutic combinations exist, the choice of the most appropriate one is not straightforward. It depends not only on its efficacy, toxicity and rate of pharmacological interactions, but also on availability (both through healthcare system and in expanded access programs), and cost.

This observational prospective study will focus on treatment strategies in HSCT recipients with HCV infection. The main focus will be the therapeutic approach, the combination of drugs chosen, the length of treatment and the outcome. The main reasons for treating or not treating HSCT recipients with HCV infection will be also explored. Compared to previous cohorts, this study might provide additional data in the area of non-invasive assessment of fibrosis, HCV-RNA levels and genotyping.