A prospective trial of vaccine to prevent hepatitis B virus reactivation after hematopoietic stem cell transplantation

Nishikawa, Koji; Kimura, Kiminori; Kanda, Yoshinobu; Sugiyama, Masaya; Kakihana, Kazuhiko; Doki, Noriko; Bae, Sung Kwan; Takahashi, Kazuhiro; Ishihara, Yuko; Mizuno, Ishikazu; Onishi, Yasushi; Onozawa, Masahiro; Onizuka, Makoto; Yamamoto, Masahide; Ishikawa, Tetsuya; Inoue, Kazuaki; Kusumoto, Shigeru; Hashino, Satoshi; Saito, Hidetsugu; Kanto, Tatsuya; Sakamaki, Hisashi; Mizokami, Masashi

doi:10.1038/s41409-020-0833-5

Cited by 15 publications

(16 citation statements)

References 41 publications

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“…Data from Asia-Pacific region observed 6%-29% risk of HBVr in resolved HBV patients receiving HSCT without antiviral prophylaxis [65,[79][80][81]. A meta-analysis showed that lymphoma patients receiving rituximab-containing regimens had significantly higher risk of HBVr than those receiving non-rituximab-containing regimens (10% vs 4%) [82].…”

Section: Hbsag (−)/Anti-hbc (+) Patients (Table 2)mentioning

confidence: 99%

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Lau

Wong

et al. 2021

Hepatol Int

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Background & Aim Hepatitis B reactivation related to the use of immunosuppressive therapy remains a major cause of liver-related morbidity and mortality in hepatitis B endemic Asia-Pacific region. This clinical practice guidelines aim to assist clinicians in all disciplines involved in the use of immunosuppressive therapy to effectively prevent and manage hepatitis B reactivation. Methods All publications related to hepatitis B reactivation with the use of immunosuppressive therapy since 1975 were reviewed. Advice from key opinion leaders in member countries/administrative regions of Asian-Pacific Association for the study of the liver was collected and synchronized. Immunosuppressive therapy was risk-stratified according to its reported rate of hepatitis B reactivation. Recommendations We recommend the necessity to screen all patients for hepatitis B prior to the initiation of immunosuppressive therapy and to administer pre-emptive nucleos(t)ide analogues to those patients with a substantial risk of hepatitis and acute-on-chronic liver failure due to hepatitis B reactivation.

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Section: Hbsag (−)/Anti-hbc (+) Patients (Table 2)mentioning

confidence: 99%

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Lau

Wong

et al. 2021

Hepatol Int

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“…There is a consensus that these patients should have prophylactic treatment with either entecavir or tenofovir if they were to undergo chemotherapy or potent immunosuppression. There have been few small studies with discordant results after HBV vaccination in those with occult HBV infection 74 , 75 . Based on the current evidence, there is no role for HBV vaccination in these patients.”…”

Section: Hepatitis B Vaccinementioning

confidence: 99%

Vaccination in Chronic Liver Disease: An Update

Alukal

Naqvi

Thuluvath

2022

Journal of Clinical and Experimental Hepatology

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Patients with chronic liver disease with or without cirrhosis remain at risk of developing hepatic decompensation when infected with viral or bacterial pathogens. The Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination in CLD against hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcus, herpes zoster, tetanus, diphtheria, pertussis and SARS-CoV-2. Inactivated vaccines are preferred over live attenuated ones, especially in transplant recipients where live vaccines are contraindicated. As the severity of the liver disease progresses, vaccine efficacy declines and therefore, vaccines should be ideally administered early in the disease course for optimal immune response. Despite the strong recommendations, overall vaccination coverage in CLD remains poor; however, it is encouraging to note that in recent years coverage against influenza and pneumococcus have shown some improvement. Inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement for healthcare providers and vaccine misinformation are often responsible for low immunization rates. This review summarizes the impact of vaccine preventable illness in those with CLD, updated vaccine guidelines, seroconversion rates in the vaccinated and barriers faced by healthcare professionals in immunizing those with liver disease.

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“…None of the 21 patients in the vaccine group developed HBVr, which indicated that HBV vaccination of HSCT recipients was a promising method for preventing HBVr. However, the following multicenter prospective clinical research of hepatitis B vaccine to prevent HBVr after allo-HSCT failed to find the protective role of hepatitis B vaccine in minimizing the risk of HBVr in HBV-resolved recipients ( 31 ). Only 37% (10/27) of patients had HBsAb with three doses of hepatitis B vaccine 12 months after HSCT, and the 2-year cumulative incidence of HBVr was 27.3%.…”

Section: Hbv Vaccine Issuesmentioning

confidence: 99%

Management of Hepatitis B Virus in Allogeneic Hematopoietic Stem Cell Transplantation

Huang

Luo

2021

Front. Immunol.

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The high morbidity of HBV reactivation following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is partially due to the intense immunologic potency of complex therapeutic regimens, the use of antithymocyte globulin and calcineurin inhibitors to prevent graft versus-host disease (GVHD), prolonged immune reconstitution, and hematological malignancies infected with hepatitis B virus (HBV). Immunosuppression results in the reactivation of HBV replication from covalently closed circular DNA (cccDNA) residing in hepatocytes. However, the role of viral mutations during HBV reactivation needs to be validated. All individuals scheduled to receive allo-HSCT or wish to donate stem cells should be screened for hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core (anti-HBc), and HBV-DNA. HBsAg-positive recipients of allo-HSCT have a high risk of HBV reactivation; thus, they should receive prophylactic antiviral therapy. The high barrier to resistance nucleos(t)-ide analogs (NAs) seems to be superior to the low barrier agents. Resolved-HBV recipients have a lower risk of HBV reactivation than HBsAg-positive recipients. Although prophylactic antiviral therapy remains controversial, regular monitoring of alanine transaminase (ALT) and HBV-DNA combined with preemptive antiviral treatment may be an optimized strategy. However, optimal antiviral therapy duration and time intervals for monitoring remain to be established. Accepting stem cells from HBsAg-positive donors is associated with a risk of developing HBV-related hepatitis. The overall intervention strategy, including donors and recipients, may decrease the risk of HBV-related hepatitis following HSCT from HBsAg positive stem cells. In this review, we summarize the issues of HBV in allo-HSCT, including HBV reactivation mechanism, HBsAg-positive recipients, HBV-resolved infection recipients, and donor-related factors, and discuss their significance.

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A prospective trial of vaccine to prevent hepatitis B virus reactivation after hematopoietic stem cell transplantation

Cited by 15 publications

References 41 publications

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Vaccination in Chronic Liver Disease: An Update

Management of Hepatitis B Virus in Allogeneic Hematopoietic Stem Cell Transplantation

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