Reactivation Of Hepatitis B Virus Infection After Allogeneic Haematopoietic Stem Cell Transplantation

BACKGROUND:Allogeneic hematopoietic cell transplantation(HCT)is increasingly being used for treatment of various hematological and oncological diseases in China.China is also endemic for hepatitis B virus(HBV)infection,with a carrier rate of approximately 10%.HBV infection patients undergoing haemopoietic stem cell transplantation(HSCT)are at risk of hepatitis reactivation and fatal liver failure. Reactivation of HBV is a well-recognized complication in patients with chronic HBV infection undergoing cytotoxic or immunosuppressive therapy.Risk factors associated with HBV reactivation include detectable hepatitis B surface antigen (HBsAg),HBV-DNA,Hepatitis B e(HBeAg)antigen,antibodies to hepatitis B core antigen(HBcAb),treatment with corticosteroids,young age and male gender. anti-viral agents including lamivudine adefovir and entecavir is safe and effective for the prevention of HBV reactivation in an HSCT setting and significantly decreases reactivation hepatitis after transplantation.Currently lamivudine is the primary agent for treatment for HBV reactivation,which is a nucleoside analogue,inhibits the viral DNA polymerase,thus rapidly and effectively interfering with viral replication,with minimal toxicity.Both adefovir and entecavir are effective against YMDD mutants. OBJECTIVE:This study evaluate Hepatitis B virus reactivation after allogeneic haematopoietic stem cell transplantation(allo-HSCT)and the safety and effectiveness of anti-HBV therapy.METHODS:We reviewed the medical records of 97 consecutive patients who had available HBV-DNA and HBV serologic data after allogeneic HSCT.Patient information was retrospectively collected from October 2005 to December 2007.RESULTS:Before transplantation,1 of 97 patients(1.0%)was positive for hepatitis B surface antigen(HBsAg)and the donor was HBsAg positive too.5 donors(5.2%) were HBsAg positive.10 recipients(10.3%)were positive for hepatitis B surface antigen(HBsAg).34 recipients(35.1%)were positive for hepatitis B core antibody (HBcAb).After transplantation,there were 2 cases(2.1%)of reactivation of HBV among these patients,both occurred in patients(5.9%)who were positive for hepatitis B core antibody(HBcAb).As to recipients who were HBsAg positive,the incidence of Hepatitis B virus reactivation in patients who did not receive anti-viral treatment is significant higher than that in patients who did(33.3%VS 0%).Donor HBsAg(+)/recipient HBsAg(+):1 patient received anti-viral treatment without Hepatitis B virus reactivation during seven months after transplantion..Donor HBsAg(+)/recipient HBsAg(-)4 patients received hepatitis B immunoglobulin as prophylaxis without Hepatitis B virus reactivation during 7 months(7-8)after transplantion,except one patient relapsed.Donor HBsAg(-)/recipient HBsAg(+)1 of 3 patients who did not receive anti-viral treatment was diagnosed as having hepatitis B caused by HBV reactivation after 6 months,other 6 patients received anti-viral treatment without Hepatitis B virus reactivation after transplantion,except one patient died.Donor HBsAg(-)/recipient HBsAg(-)HBcAb(+)16 patients were positive for HBsAb,and 15 patients without Hepatitis B virus reactivation after transplantion,except one patient died.8 patients were negative for HBsAb,There was 1 case of reactivation of HBV among these patients who died of fulminant hepatic failure.Donor HBsAg(-)/recipient HBsAg(-)HBcAb(-)59 patients did not develop HBV infection during 15.5 months(3-28)after transplantion,except 4 patient died.CONCLUSION:HBV infection patients undergoing haemopoietic stem cell transplantation (HSCT)are at risk of hepatitis reactivation.Risk factors associated with HBV reactivation include detectable hepatitis B surface antigen(HBsAg),HBV-DNA, Hepatitis B e(HBeAg)antigen,antibodies to hepatitis B core antigen(HBcAb). Donors and recipients infected with hepatitis B are not contraindication of HSCT. patients who were HBsAg negative and whose donors were HBsAg positive could received hepatitis B immunoglobulin as prophylaxis.Anti-viral agents including lamivudine adefovir and entecavir is safe and effective for the prevention of HBV reactivation in an HSCT setting and significantly decreases reactivation hepatitis after transplantation.