Objective: To evaluate the effect of hepatitis B virus (HBV) infection on the outcome of hematopoietic stem cell transplantation (HSCT).
Methods: Among 279 patients with blood diseases underwent HSCT from 2001 to 2006, clinical data of 43 patients with HBV were analyzed retrospectively.
Results: (1) There was no significant difference in the engraftment of hematopoietic stem cells between HBV infected group and control group. (2) In all the HLA-matched allogeneic HSCTs, the incidence rates of hepatic veno-occlusive disease (HVOD) (31.8%), hepatic complications (72.7%) and fatal hepatic lesion (27.3%) were all significantly higher in HBV group than those in control group (P < 0.05). (3) Through univariate analysis, the risk factors of hepatic complications in HBV group were: pretransplant hepatic dysfunction; progression phase of primary disease; allo-HSCT; having used cyclosporine as graft-versus-host disease (GVHD) prophylaxis drug. Donor's age older than 25; pretransplant hepatic dysfunction; progression phase of primary disease; total body irradiation (TBI) conditioning regimen; TBI abdomen dosage was over 7 Gy etc. were the risk factors of HVOD. However, pretransplant hepatic dysfunction; progression phase of primary disease were among the risk factors causing fatal hepatic lesion. (4) The mortality rate in HBV group (51.2%) was significantly higher than that in the control group (23.9%). The major causes of death were multiple organ failure (MOF) and liver function failure (LF). Deterioration of LF was occurred in patients with allo-HSCT during immunosuppressive agent tapered off. (5) The accumulated survival rate in HBV group was significantly lower than that in the control group (P = 0.023).
Conclusion: Donors and recipients infected with HBV were not contradictive to HSCT. The proper time of HSCT and suitable HSCT schedule could control some of the transplantation risk factors and might be helpful in reducing the mortality rate and improving the quality of life through enhancing the curative effect.