Hepatitis C virus genotypes and liver disease in patients undergoing allogeneic bone marrow transplantation

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Summary:Abnormal liver function before allogeneic BMT has been associated with VOD. Hepatitis G virus/GB virus C (HGV) is a recently discovered virus suggested to be a cause of non-A, non-B, non-C, non-D and non-E hepatitis. The aim of this retrospective study was to analyze the risk for liver complications and time to engraftment in patients infected with HGV. Fifty patients transplanted in 1995 were examined with RT-PCR for HGV on samples collected before, and between 3 and 6 months after BMT. Seven patients had HGV detected before BMT. No patient became infected during or early after the BMT. There were no differences in either preor post-transplant liver function abnormalities, VOD, or time to neutrophil engraftment in patients who did or did not have HGV detected before BMT. We conclude that the importance of HGV infection for the development of post-transplant complications is limited. Keywords: hepatitis G virus; GB virus C; VOD; engraftment Liver function abnormalities are common after allogeneic BMT. Veno-occlusive disease (VOD) of the liver is a severe and frequently fatal complication. Several risk factors have been associated with development of VOD including advanced disease, conditioning regimens containing busulphan and abnormal liver function BMT. 1,2 The roles of active hepatitis B and C virus infections before BMT in subsequent liver damage have been controversial with some studies indicating an increased risk of liver damage after BMT and other studies showing no increase in risk. [3][4][5][6] HGV is a recently discovered RNA virus that can be transmitted by blood transfusions. 7 Therefore, many BMT patients can be assumed to be infected at the time of bone marrow transplantation. The aim of this study was to investigate the role of HGV in the development of liver damage in BMT recipients.

mentioning

confidence: 99%

Detection of hepatitis G virus/GB virus C after allogeneic bone marrow transplantation

Ljungman

Halasz

Hägglund

et al. 1998

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“…1,5,6 The patient's clinical history and lack of evidence of HBV in BM and blood donors supports the conclusion that the HBV hepatitis in this patient occurred from a latent infection.…”

Section: Discussionmentioning

confidence: 54%

“…5,6 In the present case, the time course of decreasing serum titers for HBsAb was clearly demonstrated using Table 1 Serological data of HBV immunity before and after the onset of acute interic hepatitis CLIA = chemiluminescent immunoassay; RIA = radioimmunoassay; TMA = transcription mediated amplification; LGE = log genome equivalents (3.7 10 copies/ml = 3.7 LGE/ml).…”

Section: Discussionmentioning

confidence: 99%

Lamivudine treatment for reverse seroconversion of hepatitis B 4 years after allogeneic bone marrow transplantation

Hashino

Nozawa

Izumiyama

et al. 2002

Summary:Reverse seroconversion of hepatitis B virus (HBV) after allogeneic BMT is rare. We present a case of HBV reactivation late after allogeneic BMT which responded well to lamivudine therapy. A 35-year-old woman with CML received an allogeneic BMT. Before BMT, the patient had immunity to HBV, with serum antibodies against hepatitis B surface antigen (HBsAb), and the donor was completely negative for HBV. Four years after BMT, acute hepatitis occurred with a detectable level of HBV-DNA. Lamivudine rapidly reduced transaminase and bilirubin levels, and serum HBV-DNA decreased to negative. Retrospective analysis revealed that there had been a gradual decrease in serum HBsAb titers after BMT. Administration of lamivudine immediately after HBV replication may be more effective than vaccination of hepatitis B surface antigen-negative donors before BMT. Bone Marrow Transplantation (2002) 29, 361-363. DOI: 10.1038/sj/bmt/1703387 Keywords: allogeneic BMT; hepatitis B virus; lamivudine; immunosuppression It has been suggested that hepatitis B virus (HBV) in a dormant state may persist in the setting of BMT and this has been termed 'latent' infection. Reactivation of such a latent infection has been suspected in patients who had evidence of HBV immunity and who showed positive test results for hepatitis B surface antigen (HBsAg) with or without hepatitis after BMT. 1 Lamivudine, a nucleotide analogue that specifically inhibits viral reverse transcriptase, while suppressing HBV replication, is now being used widely in patients with chronic hepatitis B. 2 Lamivudine has also been administered to patients with HBV to prevent progression to fulminant hepatitis following BMT. 3,4 We report a case of reverse seroconversion from a hepa- Case reportIn June 1996, a 35-year-old woman with chronic myelogenous leukemia received a fully HLA-matched and minor ABO-mismatched (from A to AB) allogeneic BMT in the first chronic phase from an unrelated healthy donor. The conditioning regimen consisted of ranimustine, cyclophosphamide and total body irradiation. Cyclosporin A and short-term methotrexate were administered for prophylaxis of acute GVHD. Cyclosporin A had been changed to tacrolimus because of encephalopathy. Hematopoietic engraftment was achieved, and the patient was treated with oral tacrolimus for acute hepatic GVHD. During follow-up after discharge, serum transaminase levels remained stable, and tacrolimus administration was stopped 11 months after BMT. Chronic GVHD of the skin and oral cavity with lichen planus was mild, needed no additional prednisolone, and disappeared 12 months after BMT. Thereafter, there was no clinical evidence of chronic GVHD. Before BMT, serological examination showed that the donor was negative for HBsAg and HBsAb, and had normal liver function, while the patient was positive for anti-HBs and had antibodies to hepatitis B core antigen and was negative for antibodies against hepatitis B e antigen (HBeAb). Tests conducted at the Japan Red Cross Hokkaido Blood Center showed that all of the patient...

“…Reactivation of hepatitis B has been described in patients after allogeneic bone marrow transplantation, but has always occurred in patients who had markers of chronic hepatitis B, and were HBsAg positive. [4][5][6] Only one case of fatal hepatitis reactivation in a patient who had successfully recovered from a previous HBV infection has been described in 1989 after autologous bone marrow transplantation (ABMT) in a patient with acute lymphoblastic leukemia. 7 It is interesting to note that the liver damage appeared in the same interval as in our patient, about 2 months after ABMT.…”

Section: Discussionmentioning

confidence: 99%

Acute hepatitis B after autologous stem cell transplantation in a man previously infected by hepatitis B virus

Sénécal

Pichon

Dubois

et al. 1999

Summary:We report a case of acute hepatitis B after autologous stem cell transplantation (ASCT) in a patient with lowgrade non-Hodgkin's lymphoma. At diagnosis of the hematological disease, the patient had the characteristic serology of a previous hepatitis B infection, being Ag HBs negative, hepatitis B virus core antibody positive (anti-HBC) and hepatitis B virus surface antibody weakly positive. He developed fatal hepatitis B after autologous stem cell transplantation, suggesting reactivation consequent to immunosuppression.