Hepatitis E virus infection after haploidentical haematopoietic stem cell transplantation: incidence and clinical course

Abstract

Summary Hepatitis E virus (HEV) is increasingly found to cause hepatitis in allogeneic haematopoietic stem cell transplantation (HSCT) patients. However, little is known about HEV infection in patients receiving haploidentical HSCT (haplo‐HSCT). Here, we retrospectively evaluate the incidence and clinical course of HEV infection in haplo‐HSCT patients. From January 2014 to July 2017, 177 patients with unexplained elevated transaminases after receiving haplo‐HSCT at Peking University Institute of Haematology were screened for HEV using HEV serology. HEV RNA was assessed in blood samples when HEV‐IgG and/or IgM antibodies were positive. Acute HEV infection was identified in 7 patients (3·9%), 1 of whom had developed a chronic HEV infection. The median time from haplo‐HSCT to HEV infection was 17·5 (range, 6–55) months. HEV infection was confirmed by the presentation of anti‐HEV IgM + anti‐HEV IgG (rising) (n = 5) or HEV‐RNA + anti‐HEV IgM + anti‐HEV IgG (n = 2). None of the patients died of HEV infection directly: 2 patients with HEV infection died showing signs of ongoing hepatitis, and 5 patients cleared HEV with a median duration of HEV infection of 1·5 (range, 1·0–5·7) months. In conclusion, HEV infection is a rare but serious complication after haplo‐HSCT. We recommend screening of HEV in haplo‐HSCT.

Basiliximab as Treatment for Steroid-Refractory Acute Graft-versus-Host Disease in Pediatric Patients after Haploidentical Hematopoietic Stem Cell Transplantation

“…on days -5 to -4, methyl chloride hexamethylene urea nitrate (250 mg/m 2 /day orally) once on day À3, and rabbit ATG (Sang Stat, Lyon, France; 2.5 mg/kg/day i.v.) on days À5 to À2 [29,30]. One patient received a total body irradiationÀbased conditioning regimen of 7.7 Gy on days À6 plus cyclophosphamide and ATG as previously described [29,30].…”

“…on days À5 to À2 [29,30]. One patient received a total body irradiationÀbased conditioning regimen of 7.7 Gy on days À6 plus cyclophosphamide and ATG as previously described [29,30]. For patients with severe acquired aplastic anemia receiving haplo-HSCT, the conditioning regimen was a combination of i.v.…”

Hepatitis E virus in hematopoietic stem cell transplant recipients: A systematic review

“…The fact that there is no standardized case definition, in addition to the heterogeneity in the analytical sensitivity of the commercial HEV assays, makes the comparison of studies more difficult. In this systematic review, all the seven studies performed the detection of HEV RNA, the most robust marker of acute/active infection [18,21,[35][36][37][38][39], while four performed also the detection of anti-HEV IgM/IgG [18,35,37,38]. The studies that performed HEV RNA detection as the diagnostic method for HEV infection in HSCT recipients revealed similar results between them, with an overall prevalence of HEV infection of 1.5%.…”

“…After the full revision process, we included 7 manuscripts for data analysis [18,21,[35][36][37][38][39] (Table 1). Overall, these 7 studies included a total of 1178 HSCT patients from different countries: six studies were performed in Europe (United Kingdom, Netherlands, France, and Germany) [18,21,36,36,37,38,39] and one study in China 35].…”

“…Here, we briefly resume the data from all included studies. In China, a study evaluated HEV infection in 177 haploidentical-HSCT recipients that presented unexplained elevated transaminases after transplant, identifying 7 patients with an acute/current HEV infection (2 positives for HEV RNA and 5 positives for anti-HEV IgM/IgG) [35]. In the United Kingdom, two studies identified a total of 4 recipients with an acute HEV infection based in the presence of HEV RNA: in one study, 259 HSCT recipients (111 allo-HSCT, 145 auto-HSCT, and 3 CD34 top-up procedures) were evaluated and only 1 HEV RNA positive patient was identified [39]; while the other study analyzed 144 allo-HSCT recipients and 3 patients were positive for HEV RNA [21].…”