title: Hepatitis B reactivation in HBsAg-negative/HBcAb-positive allogeneic haematopoietic stem cell transplant recipients: risk factors and outcome.
abstract: HBsAg-negative/HBcAb-positive haematopoietic stem cell transplant (HSCT) recipients are at high risk of hepatitis B virus (HBV) reactivation. Allogeneic HSCT recipients from years 2000 to 2010 were evaluated in order to study the impact of being HBsAg-negative/HBcAb-positive in this population. Overall, 137 of 764 patients (18%) were HBsAg-negative/HBcAb-positive before HSCT. Overall survival, non-relapse mortality (NRM), acute and chronic graft-vs.-host disease were similar in HBcAb-positive and HBcAb-negative patients. Reactivation occurred in 14 patients (10%) within a median of 19 months after HSCT (range 9-77). Cause-specific hazard for reactivation was decreased in the case of an HBV-immune/exposed donor (HRadjusted = 0.12; 95% CI, 0.02-0.96; p 0.045) and increased in patients who received rituximab treatment (HRadjusted = 2.91; 95%CI, 0.77-10.97; p 0.11). Competing risk analyses documented a protective role of an HBV-immune/exposed donor (p 0.041) and an increased probability associated with the length of treatment with cyclosporine (p <0.001) and treatment with rituximab (but not with low-dose rituximab prophylaxis, p <0.001 at each landmark point). No differences in overall survival and NRM were found between patients with and without HBV reactivation. The donor's immunity was independently and consistently associated with a decreased risk of HBV reactivation, while rituximab and cyclosporine treatments increased the probability.
authors.affiliation: Division of Infectious Diseases, IRCCS AOU San Martino - IST, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mikulska
authors.forename: L
authors.initials: L
authors.lastname: Nicolini
authors.forename: A
authors.initials: A
authors.lastname: Signori
authors.forename: G
authors.initials: G
authors.lastname: Rivoli
authors.forename: V
authors.initials: V
authors.lastname: Del Bono
authors.forename: A M
authors.initials: AM
authors.lastname: Raiola
authors.forename: C
authors.initials: C
authors.lastname: Di Grazia
authors.forename: A
authors.initials: A
authors.lastname: Dominietto
authors.forename: R
authors.initials: R
authors.lastname: Varaldo
authors.forename: A
authors.initials: A
authors.lastname: Ghiso
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects; D002648:Child; D016572:Cyclosporine / Q000009:adverse effects; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006514:Hepatitis B Surface Antigens / Q000032:analysis*; D006515:Hepatitis B virus / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D000069283:Rituximab; D016019:Survival Analysis; D066027:Transplant Recipients; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014775:Virus Activation; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents; D000069283:Rituximab; D016572:Cyclosporine
keywords: Bone marrow transplant; chronic graft-vs.-host disease; cyclosporin; occult HBV; resolved HBV hepatitis; reverse seroconversion; rituximab