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Effectiveness of prophylactic antiviral therapy in reducing HBV reactivation for HBsAg-positive recipients following allogeneic hematopoietic stem cell transplantation: a multi-institutional experience from an HBV endemic area

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Abstract

Hepatitis B virus reactivation (HBVr) is not uncommon in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Hepatitis B surface antigen (HBsAg)-positive patients receiving allo-HSCT have a very high risk of HBVr. However, the validity of prophylactic antiviral treatment in HBsAg-positive allo-HSCT recipients has not been well studied. We aimed to add experience in dealing with HBsAg-positive patients following allo-HSCT. We conducted a cohort study that included 11 years of data of HBsAg-positive allo-HSCT patients in multiple centers. The cumulative incidence of HBVr with antiviral prophylaxis at 60 months following transplantation was 8.9%. Both lamivudine (LAM) and entecavir (ETV) effectively reduced the incidence of HBVr. Patients with absent-mild cGVHD had a lower HBVr rate than that of patients with moderate-severe cGVHD (HR = 0.201, P = 0.020). The incidence of HBsAg seroclearance at 60 months following transplantation was 34.3%. Recipients accepting from anti-HBs–negative donors were associated with a lower HBsAg seroclearance rate than that of those accepting from anti-HBs–positive donors (HR=0.255, P < 0.001). The peripheral blood stem cell (PBSC) donor source had a higher HBsAg seroclearance rates than that of the PBSC plus bone marrow stem cell source (HR = 4.700, P = 0.047). The prophylactic antiviral treatment effectively reduced HBVr in HBsAg-positive recipients receiving allo-HSCT. HBsAg-positive recipients accept anti-HBs-positive PBSC donor sources may facilitate the acquisition of HBsAg seroclearance after transplantation.

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Figure 1
Figure 2

source and PBSC+ bone marrow donor source. B Cumulative incidence of HBsAg seroclearance between the lamivudine and entecavir groups

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Acknowledgments

We thank the support of the Zhejiang Province Bone Marrow Transplant Collaboration for this retrospective study. The authors thank Professor Wangjian Zhang (Department of Medical Statistics, School of Public Health, Sun Yat-sen University) for critically reviewing the statistical methods in this manuscript.

Funding

This work was supported by grants from The National Key Research and Development Program of China (2018YFA0107804) and the National Natural Science Foundation of China (81970158).

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Author notes

  1. Yibo Wu and Yi Chen equally contributed to the work

Authors and Affiliations

  1. Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China

    Yibo Wu, Panpan Zhu, Jimin Shi, Yanmin Zhao, Jian Yu, Xiaoyu Lai, He Huang & Yi Luo

  2. Liangzhu Laboratory, Zhejiang University Medical Center, 369 West Wenyi Road, 311121, Hangzhou, China

    Yibo Wu, Panpan Zhu, Jimin Shi, Yanmin Zhao, Jian Yu, Xiaoyu Lai, He Huang & Yi Luo

  3. Institute of Hematology, Zhejiang University, Hangzhou, China

    Yibo Wu, Panpan Zhu, Jimin Shi, Yanmin Zhao, Jian Yu, Xiaoyu Lai, He Huang & Yi Luo

  4. Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China

    Yibo Wu, Panpan Zhu, Jimin Shi, Yanmin Zhao, Jian Yu, Xiaoyu Lai, He Huang & Yi Luo

  5. Department of Hematology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

    Yi Chen

  6. Department of Hematology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

    Baodong Ye

  7. Department of Hematology, the Affiliated People’s Hospital of Ningbo University, Ningbo, China

    Ying Lu & Ting Si

  8. Department of Hematology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China

    Yamin Tan

  9. Department of Hematology, People’s Hospital of Hangzhou Medical College, Hangzhou, China

    Jianping Lan

  10. Department of Hematology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Lihong Ni

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  1. Yibo Wu
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  2. Yi Chen
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Contributions

YW, analyzing data, writing of the original draft; YC, BY, YL, YT, JS, YZ, JY, XL, JL, recruiting patients, data collecting, discussing the results; PZ, re-analysis of the data and re-editing of the manuscript during revision; TS, LN, data collecting, discussing the results; HH, funding acquisition, project administration, and validation; YL, funding acquisition, project administration, review, and validation.

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Correspondence to Yi Luo.

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Wu, Y., Chen, Y., Zhu, P. et al. Effectiveness of prophylactic antiviral therapy in reducing HBV reactivation for HBsAg-positive recipients following allogeneic hematopoietic stem cell transplantation: a multi-institutional experience from an HBV endemic area. Ann Hematol 101, 631–641 (2022). https://doi.org/10.1007/s00277-021-04730-6

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