effect of Ribavrin on bone marrow

Hello,

my question is does ribavrin and pgylated interferon treatment has some side effects on the bone marrow.  As leukocytopenia and haemolysis occurs, does it mean that this treatment interferes with the working of the bone marrow.  My daughter had bone marrow transplant in November 2009.  she was incidentally found to be HCV positive.  Had HCV RNA qualitative which was negative.  Presence of antibodies which means that she got infected but recovered (as told by my doctor).  BMT done.  now doctors have opinion that the HCV got reactivated due to use of immunosuppresant.  Met two gastroenterologist, both have divergent views regarding interferon treatment.  Neither of them had previously treated post BMT case.  Guys! i am totally confused if you have some gastroenterologist in your circle who can gave his opinion regarding our situation i will be highly obliged.  Sent reports to gastroenterologists in india, but none replied.  Any one with Post BMT experience will be highly appreciated. I am so much confused whether to start, or wait and the condition of my daughter is very weak after such a long period of hospital stays and her bone marrow transplant regimens.

love you all

walia    

[HectorSF]

Bone Marrow Toxicity

PEGASYS suppresses bone marrow function and may result in severe cytopenias. Ribavirin may Increase the effect of the neutropenia and lymphopenia induced by alpha interferons including PEGASYS. Very rarely alpha interferons may be associated with aplastic anemia. It is advised that complete blood counts (CBC) be obtained pre-treatment and monitored routinely during therapy.

PEGASYS and COPEGUS should be used with caution in patients with baseline neutrophil counts < 1500 cells/mm3, with baseline platelet counts < 90,000 cells/mm3 or baseline hemoglobin < 10 g/dL. PEGASYS therapy should be discontinued, at least temporarily, in patients who develop severe decreases in neutrophil and/or platelet counts.


Hopefully others will have some experience with this.
Hectorsf

[HectorSF]

Bone Marrow Toxicity

PEGASYS suppresses bone marrow function and may result in severe cytopenias. Ribavirin may Increase the effect of the neutropenia and lymphopenia induced by alpha interferons including PEGASYS. Very rarely alpha interferons may be associated with aplastic anemia. It is advised that complete blood counts (CBC) be obtained pre-treatment and monitored routinely during therapy.

PEGASYS and COPEGUS should be used with caution in patients with baseline neutrophil counts < 1500 cells/mm3, with baseline platelet counts < 90,000 cells/mm3 or baseline hemoglobin < 10 g/dL. PEGASYS therapy should be discontinued, at least temporarily, in patients who develop severe decreases in neutrophil and/or platelet counts.


Hopefully others will have some experience with this.
Hectorsf

[Diane12855]

Look for a hepatologist. The GI I went to when I first found out about my HCV didn't know as much about this virus and treatment as these people on this forum know so I found a liver specialist. If the HCV RNA quantitative came back negative... why are they saying she is infected? That makes no sense to me at all.

Diane

[FlGuy]

I think that before the thought of HCV treatment is weighed you should make sure if your daughter has HCV.  Repeat the HCV RNA qualitative (or quantitative) before proceeding further, if the most recent was negative as it seems it was.

[jwalia]

Dear  Diane 12855 and FIGuy.
Quantitative  that she had initially was 12100000 IU/ML now latest had 1420000 IU/ML.  The qualitative which they had done was before BMT.  The doctors says that the virus got reactivated during her immunosuppressant therapy.  I met two GIs and both have treated Hep.C but they have never dealt with the case after BMT is done.  Secondaly all of them takes a divergent view.  one wants to start interferon, other wants to wait.  She seems so fragile right now, don't how she will tolerate this therapy.

[nygirl7]

Quite probably she was still positive all along but the test that they used was inadequate to find that out - thats the problem the very best test only goes down to <2 so there is still always a chance....

That's my real guess anyway.

The good news is she is young and has only had this a very short time so most likely she has very little liver damage. That being the case she would not need to treat immediately while she is so fragile. I would quite honestly advise you to at least get the biopsy to confirm that she has little or no damage (it sounds dreadfully painful but it's not, at all just nerve wracking because you can't believe it's not going to be) and then wait.  There are new drugs on the horizon that potentially could be out as early as next year (hopefully) that will not only give her better odds of success but also shorten the length of treatment (this is if she is a genotype 1 which is the most common - that is who the new meds will be for right away).  She could not only build up her strength in the meantime but also hopefully get the better drugs too .....

Treatment is tough on most even for the hardiest of us, if she has time to wait then I'd wait.  You'll  have to monitor her by having a biopsy every once in a while (every 2 or 3 years) to make sure the damage isn't progressing very fast for some reason (most of us have had the disease over 20 years and never even knew it) but the new meds should be out by then and she should be stronger so you've sort of accomplished everything you need to anyway.

I wish you all the luck in the world.  Hepc isn't great but as a disease it's OK because like I said it is so slowly progressing and the new meds will make the odds very good she will be fine.

[jwalia]

Maam,

She had a biopsy prior to her BMT.  The result of biopsy wasreported Grade IV iron overload, mild portal and focal periportal fibrosis and focal mild to moderate portal inflammation (HCV positive).  My concern is that her viral load is decreasing (88% fall) and SGOT and SGPT are also coming normal.  She has a high ferritin load 8340. As she had BMT and from what i know the Ribavarin affects the bone marrow, i just want her to get back normal.  Right now she has to undergo iron chelation and harmone therapy.  My priority is to get her iron level normal.  There is another hope in my heart that if she had recovered earlier before BMT then she can do it again.
Do you have any hepatologist in mind who can help me.  I can send him all the data pertaining to this case.  Like to have a professional view also regarding her recovery from HCV without interferon treatment.

Love you all

walia