Passive active prophylaxis against Hepatitis B in children with acute lymphoblastic leukemia

The aim of this study was to assess the antibody response to combined passive active immunisation versus active immunisation along with interferon against Hepatitis B in 60 patients with acute lymphoblastic leukemia (ALL) between 1 and 21 years of age with negative Hepatitis B virus (HBV) serology at presentation. Thirty-one patients received combined passive active immunisation with human specific Hepatitis B immunoglobulin (HEPABIG-VHB Pharmaceuticals) and Hepatitis B vaccine (arm I) and 29 patients received active immunisation along with interferon (arm II). Protective antibody levels were detected in 89.6 and 21% patients, respectively, at the 6-month evaluation. Infection with HBV occurred in 17 and 59% patients, respectively, at the 6-month evaluation. Interferon, thus, failed to serve the role as a vaccine adjuvant. At the 9-month evaluation of patients who received immunoglobulin, protective antibody titers were lost in 8 out of 19 evaluable patients (42%) and of these, 3 patients became HBsAg reactive at this point of time. This study indicated that 47.3% patients undergoing aggressive chemotherapy responded to combined passive active prophylaxis with protective titers of antiHBs at the 9-month evaluation. However, the rate of HBV infection was greatly reduced to 27%. We suggest that usage of passive immunisation in the aggressive phase, followed by active immunisation after cessation of intense chemotherapy would be a better option to increase the rates of protective antibody levels in these immunocompromised patients with leukemia.