Cerrahpasa Medical Faculty, Internal Medicine Department, Nephrology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey.
Cerrahpasa Medical Faculty, Internal Medicine Department, Hematology Section, Istanbul University - Cerrahpasa, Istanbul, Turkey.
Ann Hematol. 2020 Nov;99(11):2671-2677. doi: 10.1007/s00277-020-04206-z. Epub 2020 Jul 31.
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.
造血干细胞移植（HSCT）是病毒肝炎再激活的危险因素，因为它会影响淋巴细胞的数量和功能。潜伏的乙型肝炎病毒（HBV）可能在肝细胞中处于休眠状态，并可能在长期免疫抑制下重新激活。本研究分析了在像土耳其这样的乙型肝炎中度流行国家进行 HSCT 的患者中 HBV 感染再激活的发生率。对 1994 年至 2015 年的 561 例 HSCT 患者进行了回顾性评估。66 例患者具有 HBV 感染的血清学特征。15 例患者为乙型肝炎表面抗原（HBsAg）阳性患者（3 例为同种异体，12 例为自体），而 51 例为乙型肝炎核心 IgG 抗体（抗-HBc IgG）阳性患者（22 例为同种异体，29 例为自体）。尽管接受拉米夫定预防，但在接受自体 HSCT 的 12 例（25%）慢性 HBV（HBsAg 阳性）患者和 3 例 HBsAg 阳性患者中的 2 例接受同种异体 HSCT 的患者中观察到再激活。整个 HBsAg 阳性组的再激活率为 33%。再激活发生在中位数第 270 天（范围：60-730）。133 天时，HBsAg 阴性但抗-HBc IgG 阳性患者的逆转血清转换发生率为 10%，第 360 天增加至 17%，第 1500 天增加至 23%。对于仅抗-HBc IgG 阳性患者，累积发生率在第 2280 天增加至 41%。发现乙型肝炎表面抗体（抗-HBs）具有保护作用，因为当抗-HBs 呈阳性时，第 5050 天的再激活率未超过 11%。当根据移植类型分析抗-HBc IgG 阳性病例时，与自体 HSCT（第 5050 天的 7%）相比，同种异体 HSCT 的 HBV 再激活累积发生率更高（第 3258 天的 45%）。此外，接受同种异体移植的抗-HBc IgG 阳性患者的 HBV 再激活与死亡率有关。本研究结果表明，无论移植类型如何，均应向 HBsAg 阳性患者开具为期 1 年以上的 HBV 预防药物。如果要进行同种异体 HSCT，还应向抗-HBc IgG 阳性患者给予预防。
