Management of pegylated interferon alpha and ribavirin induced neutropenia and thrombocytopenia in patients with chronic hepatitis C

Abstract number: 1733_1388

Blessman D., Spain M., Adamski A., Mushtaq A., Koirala J., Khardori N., Htwe T.

Objective: Pegylated IFN-alpha and ribavirin is the standard treatment for chronic Hepatitis C and bone marrow suppression is a major side effect of that combination treatment. Treating with GCSF (Granulocyte Colony Stimulating Factor) for Hepatitis C treatment induced neutropenia is an option while maintaining the effective dose of pegylated IFN-alpha and ribavirin to reach sustained virologic response. We use GCSF prospectively in those patients when the absolute neutrophil count becomes less than 1000/mL and evaluate its efficacy for neutropenia and its stabilising effect on platelet count.

Method: We did a retrospective chart review of our Hepatitis C patient population. We identified a total of 222 patients from our hepatitis C database and 60 patients with thrombocytopenia (platelet count less than 140,000/uL) at any point of treatment were identified. Of these 60 patients, 30 received GCSF. In GCSF group, only 27 became eligible for evaluation. One patient had incomplete medical records and two patients were started on GCSF prior to starting treatment. In the Non-GCSF group, 23 patients were evaluated. Two patients never received Hepatitis C treatment; one patient stopped treatment due to intolerance and four patients did not have pre treatment platelet value. Both groups were divided into sub groups according to prior to GCSF treatment platelet values (less than 100,000/uL, between 100,000/uL and 139,000/uL, between 140,000/uL and 200,000/uL, and greater than 200,000/uL). The monthly platelet values in GCSF group were plotted on a line graph and trends of platelet count variations were studied. The platelet values in Non-GCSF group were followed prior to and during Hepatitis C treatment and are also plotted on a line graph.

Results: See the graph.

Average platelet values in GCSF group.

Conclusion: As shown in the graph, GCSF treatment stabilises the platelet count in patients on pegylated interferon alpha and ribavirin treatment for chronic Hepatitis C. The comparison with control will be discussed also.