title: A prophylactic approach for bone marrow transplantation from a hepatitis B surface antigen-positive donor.
abstract: It has been accepted that bone marrow transplantation (BMT) is the only curative therapeutic option for certain hematologic malignancies. The southeast Asia region is an endemic area of hepatitis B virus (HBV) infection; thus, BMT using a hepatitis B surface antigen (HBsAg)-positive donor is occasionally unavoidable. Organ transplantation using a HBsAg-positive donor can lead to post-transplantation de novo HBV infection and severe HBV-related hepatitis if no effective prophylactic measures are taken prior to and after transplantation. In this report, a four-level approach was designed for a patient with chronic myeloid leukemia, beginning with a booster HBV vaccination before performing BMT with a HBsAg-positive donor. Prior to BMT, the HBV viral load of the donor was reduced to an undetectable level by antiviral therapy. After BMT, hepatitis B immunoglobulin was administered intramuscularly for 1 wk together with a long-term antiviral drug, lamivudine. One year after discontinuation of lamivudine, the patient is still free of HBV infection.
authors: Department of Medicine, Ramathibodi hospital, 270 Praram 6 Road, Rajathevee, Bangkok 10400, Thailand. teasb@mahidol.ac.th
authors: Abhasnee
authors: A
authors: Sobhonslidsuk
authors: Artit
authors: A
authors: Ungkanont
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000276:immunology* / Q000379:methods*; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000601:surgery*; D008297:Male; D014019:Tissue Donors; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D019259:Lamivudine