Chen Yao, Xu Lan-Ping, Liu Kai-Yan, Liu Dai-Hong, Han Wei, Chen Huan, Zhang Yao-Chen, Chen Yu-Hong, Huang Xiao-Jun
Institute of Hematology, People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Nei Ke Za Zhi. 2008 Apr;47(4):316-9.
To explore the incidence and risk factors of hepatic events and overall survival among HBsAg positive leukemia patients after allo-hematopoietic stem cell transplantation (allo-HSCT).
A retrospective clinical study was conducted at the bone marrow transplant unit in our hospital between March 2001 and November 2006. A total of 26 HBsAg positive leukemia patients were included in the study. 18 patients received HLA-identical sibling allo-HSCT, 7 patients received HLA-mismatched related and 1 patient received HLA-identical unrelated. All the patients were free from hepatitis C infection before and after allo-HSCT. HBV serologic markers, including HBsAg, HBeAg, HBsAb, HBeAb and HBcAb were tested. 2 patients were positive for HBV-DNA before allo-HSCT.
The cumulative incidence for acute graft vs host disease (aGVHD) grades I -IV was 50.0%. The cumulative incidence for chronic GVHD was 25.0%. 15 (57.7%) of all the patients had abnormalities of liver function after allo-HSCT. The types of hepatic disease were reactivation of HBV and hepatic GVHD. The cumulative incidence in 5 years for hepatitis B reactivation was 33.4%, the median day of hepatitis B reactivation was 82th (65th-159th) day. The virologic and clinical outcomes were compared between two groups; one received lamivudine as prophylactic (group 1) and the other did not receive lamivudine (group 2). After transplantation, 1 patient in group 1 and 7 patients in group 2 had hepatitis due to reactivation of HBV. The cumulative incidence for hepatitis B reactivation was statistically different between the two groups (P= 0.006). None in group 1 but 4 in group 2 died of HBV-related hepatic failure. 10 of the 26 patients died after transplantation. The overall survival (OS) in 5 years was 59.0%. The causes of death included hepatic failure (5 cases), lung infection (3 cases) and relapse of leukemia (2 cases). By multivariate Cox analysis, development of hepatic failure was a significant predictor of mortality (P = 0.000).
HBsAg positive leukemia patients often suffered from hepatic injury after allo-HSCT. The principal cause of hepatic damage was the reactivation of HBV. Hepatic failure caused by HBV was the principal reason of death. Prophylaxis with lamivudine in HBsAg positive leukemia recipients can reduce the reactivation of HBV.
探讨乙肝表面抗原（HBsAg）阳性白血病患者异基因造血干细胞移植（allo-HSCT）后肝脏事件的发生率、危险因素及总生存率。
对2001年3月至2006年11月在我院骨髓移植科进行的一项回顾性临床研究。共纳入26例HBsAg阳性白血病患者。18例患者接受了人类白细胞抗原（HLA）全相合同胞allo-HSCT，7例患者接受了HLA配型不合的亲属供者移植，1例患者接受了HLA全相合非血缘供者移植。所有患者在allo-HSCT前后均未感染丙型肝炎病毒。检测HBV血清学标志物，包括HBsAg、HBeAg、HBsAb、HBeAb和HBcAb。2例患者在allo-HSCT前HBV-DNA呈阳性。
急性移植物抗宿主病（aGVHD）Ⅰ-Ⅳ级的累积发生率为50.0%。慢性移植物抗宿主病的累积发生率为25.0%。所有患者中有15例（57.7%）在allo-HSCT后出现肝功能异常。肝脏疾病类型为HBV再激活和肝脏移植物抗宿主病。乙肝再激活的5年累积发生率为33.4%，乙肝再激活的中位时间为第82天（65-159天）。比较了两组的病毒学和临床结局；一组接受拉米夫定预防（第1组），另一组未接受拉米夫定（第2组）。移植后，第1组有1例患者和第2组有7例患者因HBV再激活发生肝炎。两组乙肝再激活的累积发生率有统计学差异（P=0.006）。第1组无患者死于HBV相关肝衰竭，第2组有4例患者死于HBV相关肝衰竭。26例患者中有10例在移植后死亡。5年总生存率（OS）为59.0%。死亡原因包括肝衰竭（5例）、肺部感染（3例）和白血病复发（2例）。多因素Cox分析显示，肝衰竭的发生是死亡的显著预测因素（P=0.000）。
HBsAg阳性白血病患者allo-HSCT后常发生肝损伤。肝损伤的主要原因是HBV再激活。HBV所致肝衰竭是主要死亡原因。对HBsAg阳性白血病受者预防性使用拉米夫定可降低HBV再激活。
Zotero 插件