Effectiveness of prophylactic anti-HBV therapy in allogeneic hematopoietic stem cell transplantation with HBsAg positive donors
2005
Use of hepatitis B surface antigen (
HBsAg) positive donors for allogeneic hematopoietic stem cell transplantation (HSCT) causes serious hepatitis B virus (HBV)-related liver morbidity and mortality in the recipient. We compared the effectiveness of anti-HBV therapy in 29 recipients who underwent HSCT using
HBsAgpositive marrow (group I) against a historical control group of 25 patients who received
HBsAgpositive marrow without pre-HSCT prophylaxis (group II). Anti-HBV therapy consisted of
lamivudinefor
HBsAg-positive donors and all recipients (n = 29) as well as HBV vaccination to all
HBsAg-negative recipients (n = 10) before HSCT. After transplantation, HBV-related hepatitis was significantly higher in group II than group I recipients [12 of 25 recipients (48%) vs. 2 of 29 recipients (6.9%), p = 0.002] and in recipients whose donors had detectable serum HBV DNA by Digene Hybrid Capture II assay [8 of 14 recipients (57.1%) vs. 6 of 40 recipients (15.0%), p = 0.02]. Six recipients in group II and none in group I died of HBV-related hepatic failure (24.0% vs. 0%, p = 0.01). By multivariate Cox analysis, anti-HBV therapy effectively reduces post-HSCT HBV-related hepatitis (p = 0.01, adjusted hazards ratio 7.27, 95%CI 1.62–32.58). Our data support the use of prophylactic therapy in preventing HBV-related hepatitis after allogeneic HSCT from
HBsAg-positive donor.
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