The safety evaluation of allogenetic hematopoietic stem cell transplantation in patients with hepatitis B virus

Objective:Hepatitis B virus(HBV)infection is common in Asians,particularly in Chinese population,and may increase allogenetic hematopoietic stem cell transplantation(allo-HSCT)associated risk.If allo-HSCT is considered as an indicative therapy for the patients with hematological malignancies accompanied by active HBV infection,the transplantation has been suggested to delay until antiviral therapy is evaluated effective.Here we retrospectively analyzed impact of HBV infection on allo-HSCT safety.Method:Totally 45 patients were diagnosed as active HBV infection prior to transplantation out of all allo-HSCT performed.All those patients had hematological malignancies.HBV infection was assessed with HBV-DNA copy number.Both the patients and donors with HBV infection were treated with Lamivudine or Adefovir alone or combined prior to transplantation.Antiviral treatment was continued after transplantation,and meanwhile HBV-DNA copy number was detected regularly.The correlation of HBV infection with the time of donor cell engraftment,incidence of acute or chronic graft-versus-host disease and hepatic veno-occlusive disease(HVOD)were analyzed.Result:①The hematopoietic stem cell transplantation was not significantly affected by HBV infection following effective antiviral treatment.After transplantation 16 patients had acute graft-versus-host disease(aGVHD),with the cumulative incidence rate(37.5±7.5)%;In the 42 evaluable patients,17 patients had chronic graft-versus-host disease(cGVHD)with the cumulative incidence rate(41.6±7.8)%;Only one patient had HVOD.②Twenty-eight patients had abnormal liver function after transplantation,9 patients had HBV reactivation,and 15 patients had aGVHD or cGVHD,including 3 patients with aGVHD and cGVHD,with the cumulative incidence rate HBV reactivation(31±8.9)%,and 7 patients had drug-induced liver injury.③The median time of follow-up was 30 months after transplantation(1-74 months),there were 13 cases of death,the survival rate was(64.3±8.4)% over 3 years.The causes of death included liver failure after transplantation(4 cases),recurrence(3 cases),lung infection(3 cases),multiple organ failure(2 cases)and diffuse alveolar hemorrhage(1 case).Conclusion:Effective antiviral treatment may decrease or counteract the HBV infection associated risk in allo-HSCT settings.