High risk of hepatitis B‐virus reactivation after hematopoietic cell transplantation in hepatitis B core antibody‐positive patients

Abstract

We investigated the serological changes in hepatitis B virus (HBV)-related markers in 55 and 26 hepatitis B surface antigen (HBsAg)-negative patients undergoing allogeneic and autologous stem cell transplantation, respectively, over the past 4 yr. Five of the 17 allogeneic and one of the five autologous patients with pretransplant anti-hepatitis B core antigen antibodies (anti-HBc) were HBsAg-positive after transplantation, whereas none of the patients negative for anti-HBc were HBsAg-positive in both groups. All patients who became HBsAg-positive received steroid-containing immunosuppressive therapy for chronic graft versus host disease (GVHD) or myeloma. Four of the six patients developed flare of HBV hepatitis, and two patients did not. One patient developed fulminant hepatitis treated with lamivudine and plasma exchange. Other five patients received entecavir from the detection of HBsAg. Although HBV-DNA levels became below the limit of detection in all patients, HBsAg positivity remained in three patients after 6 months of treatment. We concluded that anti-HBc positivity is a risk factor for reactivation of HBV after both autologous and allogeneic transplantation, and HBV-related markers should be monitored regularly in these patients. We also stress the efficacy of pre-emptive use of antiviral agents in controlling HBV replication and limiting hepatic injury due to reactivation of HBV in these patients.

Reactivation of hepatitis B virus following rituximab-plus-steroid combination chemotherapy

“…The occurrence of acute or chronic graft versus host disease that requires the use of immunosuppressive drugs, such as steroids, cyclosporine or tacrolimus for long-term treatment, as well as delayed immune reconstitution may result in late onset HBV reactivation-especially in the allogeneic setting. In fact, some instances of HBV reactivation have been reported several years after allogeneic HSCT [37,38]. It is therefore necessary to remain on the alert for such a late onset pattern.…”

Severe Acute Hepatitis B in HBV-Vaccinated Partner of a Patient with Multiple Myeloma Treated with Cyclophosphamide, Bortezomib, and Dexamethasone and Autologous Stem Cell Transplant

“…It has been recommended to be used with caution in patients infected with HBV, though the role of immunomodulators in HBV reactivation is still undetermined [14]. ASCT has also been raised as a risk factor for HBV reactivation [15]. Bortezomib, a proteasome inhibitor, has been previously reported in a few cases of HBV reactivation in MM patients [10, 11].…”

Hepatitis B Related Serological Events In Hematopoietic Stem Cell Transplant Patients and Efficacy Of Lamivudine Prophylaxis Against Reactivation

“…None of the patients in prophylaxis group reactivated compared with 92% patients developing reactivation in no-prophylaxis group (P < 0.001). We used lamivudine prophylaxis only in anti-HBcIgG positive patients in view of earlier studies that concluded increased risk of HBV reactivation in patients with positive anti-HBcIgG [12,13]. Several studies have demonstrated efficacy of lamivudine in preventing HBV reactivation from HBV carrier state (HBsAg positive) in immunosuppressed patients and in those undergoing HCT [8,14,15].…”