Reverse seroconversion of hepatitis B virus infectious status after allogeneic bone marrow transplantation from a carrier donor.
A 35-year-old man with acute promyelocytic leukemia received an allogeneic bone marrow transplant (BMT) in second complete remission. The donor was his 18-year-old brother, a chronic hepatitis B virus (HBV) carrier with detectable serum hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg) and hepatitis B virus DNA (HBV DNA). Before BMT, the recipient was immune to HBV, with serum antibody to HBsAg (anti-HBs), antibody to HBeAg (anti-HBe) and normal liver function. Examination of the recipient serum drawn 2 months after BMT revealed reverse seroconversion from anti-HBs/anti-HBe to HBsAg/HBeAg, which remained positive thereafter. Upon reducing cyclosporin 6 months after BMT, acute hepatitis occurred with HBV DNA in serum as evidence of active HBV replication; the patient then developed chronic hepatitis which progressed to cirrhosis and hepatic decompensation within 8 months. Transfusion of HBV DNA/HBeAg-positive bone marrow is thus harmful even when the recipient has anti-HBs prior to BMT.
Fan
F S
FS
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
Tzeng
C H
CH
Yeh
H M
HM
Chen
P M
PM
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002353:Carrier State; D006509:Hepatitis B / Q000209:etiology* / Q000276:immunology; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000628:therapy*; D008297:Male; D012698:Serologic Tests; D014019:Tissue Donors