A Novel Strategy for the Prevention of Hepatitis B Virus-Related Hepatitis Following Allogeneic Hematopoietic Stem Cell Transplantation from Hepatitis B Surface Antigen-Positive Donors

Yibo Wu; Jimin Shi; Yamin Tan; Yanmin Zhao; Jian Yu; Xiaoyu Lai; Luxin Yang; He Huang; Yi Luo

doi:10.1016/j.bbmt.2020.05.004

A Novel Strategy for the Prevention of Hepatitis B Virus-Related Hepatitis Following Allogeneic Hematopoietic Stem Cell Transplantation from Hepatitis B Surface Antigen-Positive Donors

Biol Blood Marrow Transplant. 2020 Sep;26(9):1719-1728. doi: 10.1016/j.bbmt.2020.05.004. Epub 2020 May 17.

Authors

Yibo Wu¹, Jimin Shi¹, Yamin Tan¹, Yanmin Zhao¹, Jian Yu¹, Xiaoyu Lai¹, Luxin Yang¹, He Huang², Yi Luo³

Affiliations

¹ Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China; Institute of Hematology, Zhejiang University, Hangzhou, People's Republic of China.
² Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China; Institute of Hematology, Zhejiang University, Hangzhou, People's Republic of China. Electronic address: huanghe@zju.edu.cn.
³ Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China; Institute of Hematology, Zhejiang University, Hangzhou, People's Republic of China. Electronic address: luoyijr@zju.edu.cn.

PMID: 32434055
DOI: 10.1016/j.bbmt.2020.05.004

Abstract

Hematopoietic stem cell transplantation (HSCT) is increasingly being applied globally. Cases in which healthy HSCT donors are chronically infected with hepatitis B virus (HBV) are relatively common in areas where HBV is endemic. Recipients of stem cells from such hepatitis B surface antigen (HBsAg)-positive donors are at risk of viral infection, and thus may develop HBV-related hepatitis. Given the lack of standardized approach to minimizing the risk of such infections from HBsAg⁺ donors during HSCT, we conducted this study with the aim of developing an efficient strategy to address this challenge. A strategy comprising antiviral treatment for detectable HBV-DNA in HBsAg⁺ donors, hepatitis B immune globulin (HBIG) administration in HBsAg^- recipients with passive immunity, and prophylactic antiviral treatment for HBsAg⁺ recipients was developed. The strategy was validated using a case-control study of 40 recipients who received stem cells from HBsAg⁺ donors (group A) and 40 pair-matched controls who received stem cells from HBsAg^- donors (group B). The cumulative incidence of HBV-related hepatitis was relatively similar in the 2 groups (group A: 8.5%; 95% confidence interval [CI], -.9% to 17.9%; group B: 7.9%; 95% CI, -.9% to 16.7%; P = .939). In HBsAg^- recipients who received passive immunity from HBIG treatment, a significant negative linear correlation was observed between HBsAb titer in vivo and time in the first year after allo-HSCT (R² = .23; P < .001). This method was cost-effective, with a median cost of all HBV management of USD 332.1 (range, 172.7 to 1985.3), compared with USD 1464.9 (range 409.9 to 1985.3) for conventional strategies (P < .001). The novel strategy presented in here is robust in preventing HBV-related hepatitis after allo-HSCT with stem cells from HBsAg⁺ donors. This is important for the effective application of allo-HSCT in HBV-endemic areas without precluding the use of HBsAg⁺ donors.

Keywords: Cost-effective; HBV-related hepatitis; HBsAg- positive donor; Hematopoietic stem cell transplantation; Hepatitis B virus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Hematopoietic Stem Cell Transplantation* / adverse effects
Hepatitis B Surface Antigens
Hepatitis B virus
Hepatitis*
Humans

Substances

Hepatitis B Surface Antigens