Hepatitis B virus reactivation in patients with HBs antibodies after allogeneic hematopoietic stem cell transplantation

摘要

We retrospectively investigated the clinical characteristics of reactivation of hepatitis B (HB) virus after allogeneic hematopoietic stem cell transplantation (HSCT). Of 2002 patients who received transplantation between January 1994 and December 2004, seven patients who were anti-HB surface antibody (anti-HBs) positive and HB surface antigen (HBs-Ag) negative developed reactivation of the HB virus after allogeneic HSCT. The patients' median age was 49 years, and they consisted of 5 males and 2 females. Six of 7 recipients received hematopoietic stem cells from HLA-identical sibling donors. All donors were negative for HBs-Ag. Six donors were negative for anti-HBs and one donor was not investigated for anti-HBs. HB reactivation occurred 5 to 29 (median 15) months after HSCT. Chronic graft-versus-host-disease (GVHD) was observed in 5 cases. The peak value of GPT during HB reactivation varied from 83 to 1930 (median 318) IU/l. Lamivudine was given to 5 patients. One patient was treated with supportive therapy and other one patient was observed without treatment. Two patients developed fulminant hepatitis and died of hepatic dysfunction. Clinicians should consider the possibility of HB reactivation in anti-HBs-positive patients. The establishment of a preventive method for HB reactivation would be desirable.