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Adoptive donor immunity protects against resolved hepatitis B virus reactivation after allogeneic haematopoietic stem cell transplantation in the world's largest retrospective cohort study
Adoptive donor immunity protects against resolved hepatitis B virus reactivation after allogeneic haematopoietic stem cell transplantation in the world's largest retrospective cohort study
- Source :
- British Journal of Haematology. 186:72-85
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Reactivation of hepatitis B virus (HBV) by reverse seroconversion (HBV-RS) after allogeneic haematopoietic stem cell transplantation (allo-HSCT) can occur in patients with resolved HBV infection (rHBV, defined as negative HBV surface antigen [HBsAg] and positive HBV core antibody), and may cause fatal hepatitis. To explore the risk factors, we retrospectively identified 817 consecutive patients who underwent allo-HSCT from 2005 to 2016 in this largest single centre cohort from National Taiwan Univerisity Hospital. Transplants using donors or recipients positive for HBsAg or HBV DNA were excluded, leaving 445 rHBV patients for analysis. The 3- and 5-year cumulative incidence of HBV-RS after allo-HSCT was 8·7% and 10·5%, respectively, at a median 16 months after allo-HSCT. All had concurrent HBV reactivation. HBV flares developed in 19% of HBV-RS cases, but none experienced hepatic failure. Neither did it impact non-relapse mortality or overall survival. Multivariate analysis revealed that patients with donor lacking hepatitis B surface antibody and extensive chronic graft-versus-host disease (cGVHD) have the highest risk for HBV-RS, with 5-year incidence of 24·2%. In conclusion, adoptive immunity transfer from the donor seems to have protective effects against HBV-RS, which may alter future donor selection algorithms, and combined with extensive cGVHD provides a good target for risk-adaptive HBV prophylaxis.
- Subjects :
- Adult
Male
Hepatitis B virus
HBsAg
Adolescent
Graft vs Host Disease
Adaptive Immunity
medicine.disease_cause
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Transplantation, Homologous
Cumulative incidence
Retrospective Studies
Hepatitis
Donor selection
business.industry
Hematopoietic Stem Cell Transplantation
virus diseases
Retrospective cohort study
Hematology
Middle Aged
Hepatitis B
medicine.disease
Tissue Donors
digestive system diseases
Transplantation
Adoptive immunity
Seroconversion
030220 oncology & carcinogenesis
Immunology
Female
Virus Activation
business
030215 immunology
Subjects
Details
- ISSN :
- 13652141 and 00071048
- Volume :
- 186
- Database :
- OpenAIRE
- Journal :
- British Journal of Haematology
- Accession number :
- edsair.doi.dedup.....21bf685c7fe90f8bcf445c0a603701d9
- Full Text :
- https://doi.org/10.1111/bjh.15884