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Bone marrow transplant is a potential cure for several diseases, including cancer and specific genetic disorders. Notably, this procedure is applicable for patients suffering from aplastic anemia, certain types of leukemia, severe combined immunodeficiency disease (SCID), Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, thalassemia, sickle-cell disease, and certain cancers.
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Risk of hepatitis B surface antigen seroreversion after allogeneic hematopoietic SCT.

M Viganò1, C Vener, P Lampertico

  • 1First Division of Gastroenterology, Department of Medicine, A M and A Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy. mauro.vigano@tin.it

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Area of Science:

  • Hepatology
  • Onco-hematology
  • Infectious Disease Immunology

Background:

  • Allogeneic hematopoietic stem cell transplantation (HSCT) poses a risk for Hepatitis B virus (HBV) reactivation in carriers.
  • Limited data exists on HBV reactivation incidence, risk factors, and outcomes in Hepatitis B surface antigen (HBsAg)-negative/anti-hepatitis B core antigen (anti-HBc)-positive HSCT recipients.

Purpose of the Study:

  • To investigate the incidence, risk factors, and clinical course of HBV reactivation in HBsAg-negative/anti-HBc-positive HSCT recipients.
  • To identify predictors of HBsAg seroreversion and subsequent chronic hepatitis B development.

Main Methods:

  • A cohort of 50 HBsAg-negative/anti-HBc-positive HSCT recipients with onco-hematological diseases was monitored.
  • Sequential clinical and laboratory assessments, including serum HBsAg and HBV DNA levels (using sensitive PCR), were performed.
  • Follow-up duration was 17 months.

Main Results:

  • Six patients (12%) experienced HBsAg seroreversion 7-32 months post-HSCT, with 1- and 5-year cumulative rates of 13% and 22%, respectively.
  • HBsAg seroreversion correlated with high baseline HBV DNA levels (>8 log₁₀ copies/mL) and significant alanine aminotransferase elevation, leading to HBeAg-positive chronic hepatitis B.
  • Chronic onco-hematological disease and prolonged immunosuppression post-HSCT were identified as independent risk factors for HBsAg seroreversion.

Conclusions:

  • HBsAg-negative/anti-HBc-positive HSCT recipients, particularly those with chronic onco-hematological diseases, face a substantial risk of HBsAg seroreversion.
  • These patients are at risk for developing HBeAg-positive chronic hepatitis B, irrespective of pre-transplant HBV DNA levels.
  • Long-term immunosuppression is a critical factor contributing to HBV reactivation in this population.