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同種造血幹細胞移植後のHBV再活性化の単施設後方視的検討

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Other Title
  • ドウシュ ゾウケツ カンサイボウ イショク ゴ ノ HBV サイカッセイカ ノ タンシセツ コウホウ シテキ ケントウ
  • Retrospective single-center analysis of HBV reactivation in patients with hematological malignancies after allogenic hematopoietic stem cell transplantation
  • 同種移植後のHBV再活性化の後方視的検討

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Abstract

Reactivation of hepatitis B has been recognized as a careful adverse event after chemotherapies or immunosuppressive therapies because chronic hepatitis B leads to carcinoma and/or liver cirrhosis. Allogenic hematopoietic stem cell transplantation(allo-HSCT)against hematological diseases induces severe immunosuppression including reconstitution of naïve donor immunity against HBV-infected hepatocytes and we therefore need to follow-up HBV testing for a long term. In order to establish how to follow-up HBV-infected patients with receiving allo-HSCT, we retrospectively studied HBV serological markers and HBV-DNA in the HBV-infected patients, who received allo-HSCT and followed-up more than 1 year in our single center. We detected 7 HBV-infected and allo-HSCT-received patients, and HBV reactivation was occurred in 3 patients with detecting HBV-DNA. No patients were died due to HBV reactivation. The HBV reactivation period after receiving allo-HSCT was 16,20,79 months, respectively. All the 3 patients received nucleoside analogues(NUCs); however, the appearance of viral mutation was occurred in one patient who received lamivudine and already detected HBs-Ag before allo-HSCT. The HBV reactivation was controlled with addition of adefovir. Others were due to discontinuation of entecavir, which reason was poor medication-adherence after stopping immunosuppressive therapies. These two patients received tenofovir alafenamide in addition or retreated with entecavir, respectively, leading to disappearing of HBV-DNA. HBs-Ab were disappeared in 31 months after allo-HSCT in one patient, and then the Ab was detected after occurring HBV reactivation, suggesting reconstitution of donor immunity. Taken together, our findings suggest that we need to follow-up immune-reconstitution and regularly evaluate HBV serological markers and HBV-DNA, in addition to maintain medication-adherence.

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