title: Prophylactic antiviral therapy in allogeneic hematopoietic stem cell transplantation in hepatitis B virus patients.
abstract: OBJECTIVE
  To investigate the timing, safety and efficacy of prophylactic antiviral therapy in patients with hepatitis B virus (HBV) infection undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  METHODS
  This prospective study recruited a total of 57 patients diagnosed with malignant hematological diseases and HBV infection at the First Affiliated Hospital of Sun Yat-sen University between 2006 and 2013. The patients were classified as hepatitis B surface antigen (HBsAg)-positive or HBsAg-negative/ antiHBc-positive. Patients were treated with chemotherapy followed by antiviral therapy with nucleoside analogues. Patients underwent allo-HSCT when serum HBV DNA was < 10(3) IU/mL. Following allo-HSCT, antiviral therapy was continued for 1 year after the discontinuation of immunosuppressive therapy. A total of 105 patients who underwent allo-HSCT and had no HBV infection were recruited as controls. The three groups were compared for incidence of graft-vs-host disease (GVHD), drug-induced liver injury, hepatic veno-occlusive disease, death and survival time.
  
  
  RESULTS
  A total of 29 of the 41 subjects with chronic GVHD exhibited extensive involvement and 12 exhibited focal involvement. Ten of the 13 subjects with chronic GVHD in the HBsAg(-)/hepatitis B core antibody(+) group exhibited extensive involvement and 3 exhibited focal involvement. Five of the 10 subjects with chronic GVHD in the HBsAg(+) group exhibited extensive involvement and 5 exhibited focal involvement. The non HBV-infected group did not differ significantly from the HBsAg-negative/antiHBc-positive and the HBsAg-positive groups which were treated with nucleoside analogues in the incidence of graft-vs-host disease (acute GVHD; 37.1%, 46.9% and 40%, respectively; P = 0.614; chronic GVHD; 39%, 40.6% and 40%, respectively; P = 0.98), drug-induced liver injury (25.7%, 18.7% and 28%, respectively; P = 0.7), death (37.1%, 40.6% and 52%, respectively; P = 0.4) and survival times (P = 0.516). One patient developed HBV reactivation (HBsAg-positivity) due to early discontinuation of antiviral therapy.
  
  
  CONCLUSIONS
  Suppression of HBV DNA to < 10(3) IU/mL before transplantation, continued antiviral therapy and close monitoring of immune markers and HBV DNA after transplantation may assure the safety of allo-HSCT.
authors.affiliation: Ya-Ping Liao, Jia-Lu Jiang, Wai-Yi Zou, Duo-Rong Xu, Juan Li, Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Liao
authors.affiliation: Ya-Ping Liao, Jia-Lu Jiang, Wai-Yi Zou, Duo-Rong Xu, Juan Li, Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.
authors.forename: Jia-Lu
authors.initials: JL
authors.lastname: Jiang
authors.affiliation: Ya-Ping Liao, Jia-Lu Jiang, Wai-Yi Zou, Duo-Rong Xu, Juan Li, Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.
authors.forename: Wai-Yi
authors.initials: WY
authors.lastname: Zou
authors.affiliation: Ya-Ping Liao, Jia-Lu Jiang, Wai-Yi Zou, Duo-Rong Xu, Juan Li, Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.
authors.forename: Duo-Rong
authors.initials: DR
authors.lastname: Xu
authors.affiliation: Ya-Ping Liao, Jia-Lu Jiang, Wai-Yi Zou, Duo-Rong Xu, Juan Li, Department of Hematology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, Guangdong Province, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D002681:China; D002908:Chronic Disease; D004279:DNA, Viral / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents
keywords: Antiviral therapy; Hematopoietic stem cell transplantation; Hepatitis B virus; Nucleotide analogues