Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei 100, Taiwan.
Infection. 2011 Aug;39(4):363-5. doi: 10.1007/s15010-011-0120-x. Epub 2011 May 5.
Hepatitis B virus (HBV) infection is one of the main concerns in blood and marrow transplantation (BMT) patients for possible breakthrough hepatitis. Active recipient immunization against HBV was found to be ineffective and many studies had showed that the adoptive transfer of immunity against hepatitis B virus would be possible by BMT with unknown duration and mechanism. A 46-year-old female patient with chronic hepatitis B had persistent detectable HBV DNA and positive serum hepatitis B e antigen (HBeAg), even while on long-term lamivudine and adefovir therapy. She received allogeneic matched unrelated donor peripheral blood stem cell transplantation (allo-MUD-PBSCT) for her refractory acute myeloid leukemia (AML). The HBV DNA became undetectable and she developed HBeAg seroconversion after PBSCT. Her hepatitis B surface antigen (HBsAg) remained positive, which disappeared later, along with the development of antibody to HBsAg after one shot of donor lymphocyte infusion (DLI) as a boost against her AML. In summary, BMT from an immunized donor would probably bring adoptive immunity against HBV. This adoptive immunity might be further enhanced by the subsequent DLI.
乙型肝炎病毒 (HBV) 感染是血液和骨髓移植 (BMT) 患者的主要关注点之一，因为可能会出现突破性肝炎。已经发现，针对 HBV 的主动受者免疫接种无效，许多研究表明，通过 BMT 可以获得针对乙型肝炎病毒的被动免疫，其持续时间和机制尚不清楚。一位 46 岁的女性慢性乙型肝炎患者，即使长期接受拉米夫定和阿德福韦酯治疗，仍持续检测到 HBV DNA 和阳性血清乙型肝炎 e 抗原 (HBeAg)。她因难治性急性髓细胞白血病 (AML) 接受了同种异体匹配的无关供体外周血造血干细胞移植 (allo-MUD-PBSCT)。PBSCT 后，HBV DNA 不可检测，她发生了 HBeAg 血清学转换。她的乙型肝炎表面抗原 (HBsAg) 仍为阳性，随后在单次供者淋巴细胞输注 (DLI) 后消失，该 DLI 作为对其 AML 的增强治疗，引发了抗 HBsAg 抗体的产生。总之，来自免疫供者的 BMT 可能会带来针对 HBV 的获得性免疫。随后的 DLI 可能会进一步增强这种获得性免疫。
