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Hepatitis B reactivation in hematopoietic stem cell transplanted patients: 20 years of experience of a single center from a middle endemic country

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Abstract

Hematopoietic stem cell transplantation (HSCT) is a risk factor for viral hepatitis reactivations because it affects lymphocyte number and functions. Latent hepatitis B virus (HBV) may stay in dormant form in hepatocytes and may be reactivated in prolonged immunosuppression. This study analyzes the incidence of reactivation of HBV infections in HSCT patients in a middle endemic country like Turkey. Five hundred and sixty-one HSCT patients from 1994 to 2015 were retrospectively evaluated. Sixty-six patients had a serologic feature of HBV infection. Fifteen patients were hepatitis B surface antigen (HBsAg)-positive patients (3 allogeneic and 12 autologous) while 51 of them were anti-hepatitis B core IgG (anti-HBc IgG)-positive patients (22 allogeneic and 29 autologous). Although under lamivudine prophylaxis, reactivation was seen in three of 12 (25%) chronic HBV (HBsAg positive) patients who received autologous HSCT and in two of the three HBsAg-positive patients who received allogeneic HSCT. Rate of reactivation in the whole HBsAg-positive group was 33%. Reactivation occurred on median 270th day (range: 60–730). Reverse seroconversion incidence was 10% on 133th day for HBsAg negative, but anti-HBc IgG-positive patients, which increased to 17% on 360th and to 23% on 1500th day. Cumulative incidence increased to 41% on 2280th day for isolated anti-HBc IgG-positive patients. Hepatitis B surface antibodies (anti-HBs) were found to be protective as reactivation did not exceed 11% on 5050th day when anti-HBs was positive. When anti-HBc IgG-positive cases were analyzed according to their transplantation types, allogeneic HSCT was found to have higher cumulative incidence (45% on 3258th day) for HBV reactivation than autologous HSCT (7% on 5050th day). Besides, HBV reactivation in anti-HBc IgG-positive patients who received allogeneic transplantation was related to mortality. Findings of this study suggest that HBV prophylaxis extending over 1 year should be prescribed for HBsAg-positive patients independent of the transplantation type. Prophylaxis should also be given to anti-HBc IgG-positive patients if an allogeneic HSCT is to be performed.

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Authors and Affiliations

  1. Cerrahpasa Medical Faculty, Internal Medicine Department, Nephrology Section, Istanbul University – Cerrahpasa, Istanbul, Turkey

    Ahmet Murt

  2. Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University – Cerrahpasa, Istanbul, Turkey

    Tugrul Elverdi, Ahmet Emre Eskazan, Ayse Salihoglu, Muhlis Cem Ar, Seniz Ongoren, Zafer Baslar & Teoman Soysal

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  1. Ahmet Murt
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  2. Tugrul Elverdi
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  3. Ahmet Emre Eskazan
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  4. Ayse Salihoglu
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  5. Muhlis Cem Ar
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Correspondence to Ahmet Murt.

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The authors declare that they have no conflicts of interest.

Ethical approval

The study was approved by the Institutional Ethics Committee for Clinical Studies at Cerrahpasa Medical Faculty (Approval Number and Date: A-32/1 December 2015).

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Murt, A., Elverdi, T., Eskazan, A.E. et al. Hepatitis B reactivation in hematopoietic stem cell transplanted patients: 20 years of experience of a single center from a middle endemic country. Ann Hematol 99, 2671–2677 (2020). https://doi.org/10.1007/s00277-020-04206-z

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  • DOI: https://doi.org/10.1007/s00277-020-04206-z

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