Hepatitis B-related events in autologous hematopoietic stem cell transplantation recipients.
OBJECTIVE
To investigate the frequency of occult hepatitis B, the clinical course of hepatitis B virus (HBV) reactivation and reverse seroconversion and associated risk factors in autologous hematopoietic stem cell transplantation (HSCT) recipients.


METHODS
This study was conducted in 90 patients undergoing autologous HSCT. Occult HBV infection was investigated by HBV-DNA analysis prior to transplantation, while HBV serology and liver function tests were screened prior to and serially after transplantation. HBV-related events including reverse seroconversion and reactivation were recorded in all patients.


RESULTS
None of the patients had occult HBV prior to transplantation. Six (6.7%) patients were positive for HBV surface antigen (HBsAg) prior to transplantation and received lamivudine prophylaxis; they did not develop HBV reactivation after transplantation. Clinical HBV infection emerged in three patients after transplantation who had negative HBV-DNA prior to HSCT. Two of these three patients had HBV reactivation while one patient developed acute hepatitis B. Three patients had anti-HBc as the sole hepatitis B-related antibody prior to transplantation, two of whom developed hepatitis B reactivation while none of the patients with antibody to HBV surface antigen (anti-HBs) did so. The 14 anti-HBs- and/or anti-HBc-positive patients among the 90 HSCT recipients experienced either persistent (8 patients) or transient (6 patients) disappearance of anti-HBs and/or anti-HBc. HBsAg seroconversion and clinical hepatitis did not develop in these patients. Female gender and multiple myeloma emerged as risk factors for loss of antibody in regression analysis (P < 0.05).


CONCLUSIONS
Anti-HBc as the sole HBV marker seems to be a risk factor for reactivation after autologous HSCT. Lamivudine prophylaxis in HbsAg-positive patients continues to be effective.
Ceneli
Ozcan
O
Department of Hematology, Gazi University, Faculty of Medicine, Beşevler 06500, Ankara, Turkey.
Ozkurt
Zübeyde Nur
ZN
Acar
Kadir
K
Rota
Seyyal
S
Aki
Sahika Zeynep
SZ
Yeğin
Zeynep-Arzu
ZA
Yağci
Münci
M
Ozenirler
Seren
S
Sucak
Gülsan Türköz
GT
D000293:Adolescent; D000328:Adult; D000368:Aged; D002353:Carrier State / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006509:Hepatitis B / Q000209:etiology* / Q000276:immunology / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy / Q000821:virology; D012307:Risk Factors; D014182:Transplantation, Autologous; D055815:Young Adult
D004279:DNA, Viral; D006510:Hepatitis B Antibodies