Brief Article
Copyright ©2010 Baishideng. All rights reserved.
World J Gastroenterol. Apr 14, 2010; 16(14): 1765-1771
Published online Apr 14, 2010. doi: 10.3748/wjg.v16.i14.1765
Hepatitis B-related events in autologous hematopoietic stem cell transplantation recipients
Özcan Çeneli, Zübeyde Nur Özkurt, Kadir Acar, Seyyal Rota, Şahika Zeynep Akı, Zeynep Arzu Yeğin, Münci Yağcı, Seren Özenirler, Gülsan Türköz Sucak
Özcan Çeneli, Zübeyde Nur Özkurt, Kadir Acar, Şahika Zeynep Akı, Zeynep Arzu Yeğin, Münci Yağcı, Gülsan Türköz Sucak, Department of Hematology, Gazi University, Faculty of Medicine, Beşevler 06500, Ankara, Turkey
Seyyal Rota, Department of Microbiology, Gazi University, Faculty of Medicine, Beşevler 06500, Ankara, Turkey
Seren Özenirler, Department of Gastroenterology, Gazi University, Faculty of Medicine, Beşevler 06500, Ankara, Turkey
Author contributions: Sucak GT, Çeneli Ö, Özkurt ZN, Acar K, Rota S, Akı ŞZ, Yeğin ZA, Yağcı M and Özenirler S designed the research; Çeneli Ö and Özkurt ZN analyzed the data; Çeneli Ö and Sucak GT wrote the paper.
Supported by The Society of Postgraduate Education of Internal Medicine
Correspondence to: Dr. Gülsan Türköz Sucak, Department of Hematology, Gazi University, Faculty of Medicine, Beşevler 06500, Ankara, Turkey. aysucak@gazi.edu.tr
Telephone: +90-312-2026317 Fax: +90-312-2236714
Received: December 24, 2009
Revised: February 12, 2010
Accepted: February 19, 2010
Published online: April 14, 2010
Abstract

AIM: To investigate the frequency of occult hepatitis B, the clinical course of hepatitis B virus (HBV) reactivation and reverse seroconversion and associated risk factors in autologous hematopoietic stem cell transplantation (HSCT) recipients.

METHODS: This study was conducted in 90 patients undergoing autologous HSCT. Occult HBV infection was investigated by HBV-DNA analysis prior to transplantation, while HBV serology and liver function tests were screened prior to and serially after transplantation. HBV-related events including reverse seroconversion and reactivation were recorded in all patients.

RESULTS: None of the patients had occult HBV prior to transplantation. Six (6.7%) patients were positive for HBV surface antigen (HBsAg) prior to transplantation and received lamivudine prophylaxis; they did not develop HBV reactivation after transplantation. Clinical HBV infection emerged in three patients after transplantation who had negative HBV-DNA prior to HSCT. Two of these three patients had HBV reactivation while one patient developed acute hepatitis B. Three patients had anti-HBc as the sole hepatitis B-related antibody prior to transplantation, two of whom developed hepatitis B reactivation while none of the patients with antibody to HBV surface antigen (anti-HBs) did so. The 14 anti-HBs- and/or anti-HBc-positive patients among the 90 HSCT recipients experienced either persistent (8 patients) or transient (6 patients) disappearance of anti-HBs and/or anti-HBc. HBsAg seroconversion and clinical hepatitis did not develop in these patients. Female gender and multiple myeloma emerged as risk factors for loss of antibody in regression analysis (P < 0.05).

CONCLUSION: Anti-HBc as the sole HBV marker seems to be a risk factor for reactivation after autologous HSCT. Lamivudine prophylaxis in HbsAg-positive patients continues to be effective.

Keywords: Autologous stem cell transplantation; Hepatitis B reactivation; Occult hepatitis; Multiple myeloma; Lymphoma