Treatment induced leucopenia in hepatitis C and Role of G-CSF in its management.

OBJECTIVE To determine the frequency and severity of leucopenia during antiviral treatment in patients with hepatitis C and the effectiveness of G-CSF (Granulocyte-Colony Stimulating Factor) in its management. STUDY DESIGN An observational study. PLACE AND DURATION OF STUDY Shafi Clinic, Rawalpindi, from July 2005 to July 2007. METHODOLOGY Patients with Polymerase Chain Reaction (PCR) positive for Hepatitis C Virus-Ribonucleic Acid (HCVRNA) by Enzyme Linked Immunosorbent Assay (ELISA) method were included in the study. Standard combination therapy was given to all i.e. interferon and ribavirin. Those with total leukocyte count (TLC)<4000/cmm were given injection Granulocyte-Colony Stimulating Factor (G-CSF) according to severity of leucopenia. Response to therapy was noted and dose titration was done accordingly. RESULTS A total of 208 patients were enrolled in the study with 99 (48%) males and 109 (52%) females. Total leukocyte count (TLC)<4000/cmm was observed in 78 (37.5%) cases. Conventional interferon induced leucopenia was seen in 60 out of 172 (35%) cases. Pegylated interferon induced leucopenia was seen in 18 out of 36 (50%) cases. Patients on Pegylated interferon had more severe leucopenia as compared to those on conventional interferon. Granulocyte-Colony Stimulating Factor (G-CSF) administration resulted in an increase in mean total leukocyte count from 2300 to 5200/cmm. No patient required antiviral dose reduction or discontinuation. CONCLUSION Recombinant Granulocyte-Colony Stimulating Factor (G-CSF) administration tends to manage leucopenia, which is a common adverse effect of antiviral treatment for hepatitis C.