Hepatitis B reactivation in HBsAg‐negative/HBcAb‐positive allogeneic haematopoietic stem cell transplant recipients: risk factors and outcome. (29th March 2014)

• Record Type: Journal Article
• Authors: Mikulska, M.; Nicolini, L.; Signori, A.; Rivoli, G.; Del Bono, V.; Raiola, A. M.; Di Grazia, C.; Dominietto, A.; Varaldo, R.; Ghiso, A.; Bacigalupo, A.; Viscoli, C.; Antonelli, G.
• Is Part Of: Clinical microbiology and infection. Volume 20:Number 10(2014:Oct.)
• Page Start: O694
• Page End: O701
• Publication Date: 2014-03-29
• Subjects: Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1111/1469-0691.12611
• Languages: English
• ISSNs: 1198-743X

Abstract

<abstract abstract-type="main" id="clm12611-abs-0001"> <title>Abstract</title> <p>HBsAg‐negative/HBcAb‐positive haematopoietic stem cell transplant (HSCT) recipients are at high risk of hepatitis B virus (HBV) reactivation. Allogeneic HSCT recipients from years 2000 to 2010 were evaluated in order to study the impact of being HBsAg‐negative/HBcAb‐positive in this population. Overall, 137 of 764 patients (18%) were HBsAg‐negative/HBcAb‐positive before HSCT. Overall survival, non‐relapse mortality (NRM), acute and chronic graft‐vs.‐host disease were similar in HBcAb‐positive and HBcAb‐negative patients. Reactivation occurred in 14 patients (10%) within a median of 19 months after HSCT (range 9–77). Cause‐specific hazard for reactivation was decreased in the case of an HBV‐immune/exposed donor (HR<sub>adjusted</sub> = 0.12; 95% CI, 0.02–0.96; p 0.045) and increased in patients who received rituximab treatment (HR<sub>adjusted</sub> = 2.91; 95%CI, 0.77–10.97; p 0.11). Competing risk analyses documented a protective role of an HBV‐immune/exposed donor (p 0.041) and an increased probability associated with the length of treatment with cyclosporine (p <0.001) and treatment with rituximab (but not with low‐dose rituximab prophylaxis, p <0.001 at each landmark point). No differences in overall survival and NRM were found between patients with and without HBV reactivation. The donor's immunity was independently and consistently associated with a decreased risk of HBV reactivation, while rituximab and cyclosporine treatments increased the probability.</p> </abstract>