title: Reverse seroconversion of hepatitis B after allogeneic bone marrow transplantation: a retrospective study of 37 patients with pretransplant anti-HBs and anti-HBc.
abstract: BACKGROUND
  Reverse seroconversion to hepatitis B virus (HBV), i.e., HBV reactivation in patients with pretransplant antibodies to hepatitis B surface antigen (anti-HBs) and to hepatitis B core antigen (anti-HBc), is rarely re-ported after allogeneic bone marrow transplantation.
  
  
  METHODS
  To determine this risk, we studied clinical outcome and serological changes in 37 patients with pretransplant anti-HBs and anti-HBc.
  
  
  RESULTS
  In 33 cases, no change in HBV markers was observed in the posttransplant period. In four cases, anti-HBs and anti-HBc were lost, and hepatitis B surface antigen, hepatitis B e antigen, and HBV DNA emerged together with acute hepatitis, after cessation of immunosuppression. The actuarial risk of reactivation in the 37 patients was 20.5% (median follow-up 20 months). No reactivation occurred in patients with anti-HBs-positive donors.
  
  
  CONCLUSIONS
  Although few cases of postallogeneic bone marrow transplantation reverse seroconversion to HBV have been reported, this study demonstrates that the actuarial risk is relatively high and suggests that donor vaccination might be proposed prophylactically or that HBs-specific immunoglobulin infusions might be warranted.
authors.affiliation: Bone Marrow Transplant Unit, Henri Mondor Hospital, Créteil, France.
authors.forename: N
authors.initials: N
authors.lastname: Dhédin
authors.forename: C
authors.initials: C
authors.lastname: Douvin
authors.forename: M
authors.initials: M
authors.lastname: Kuentz
authors.forename: M F
authors.initials: MF
authors.lastname: Saint Marc
authors.forename: O
authors.initials: O
authors.lastname: Reman
authors.forename: C
authors.initials: C
authors.lastname: Rieux
authors.forename: F
authors.initials: F
authors.lastname: Bernaudin
authors.forename: F
authors.initials: F
authors.lastname: Norol
authors.forename: C
authors.initials: C
authors.lastname: Cordonnier
authors.forename: D
authors.initials: D
authors.lastname: Bobin
authors.forename: J M
authors.initials: JM
authors.lastname: Metreau
authors.forename: J P
authors.initials: JP
authors.lastname: Vernant
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D005260:Female; D006509:Hepatitis B / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000032:analysis; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000254:growth & development*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents