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HBV reactivation prevalent after hematopoietic stem cell transplant

VIENNA — Hepatitis B virus infection reactivation was prevalent in treatment-naive patients undergoing hematopoietic stem cell transplantation, according to data presented at the 2015 International Liver Congress.

Wai-Kay Seto, MD, department of medicine, The University of Hong Kong, China, and colleagues recruited treatment-naive patients negative for hepatitis B surface antigen (HBsAg) and positive for antibody to the hepatitis B core antigen (anti-HBc) undergoing either autologous or allogeneic hematopoietic stem cell transplantation (HSCT) at Queen Mary Hospital in Hong Kong. Overall, 350 recruited patients were undergoing HSCT, of which 26.9% (n = 94) were HBsAg-negative and anti-HBc-positive.

Of the 94 patients, 73.4% (n = 69) fulfilled all inclusion criteria and were included in the analyses. All patients had undetectable serum HBV DNA levels at baseline (< 10 IU/mL) and the median duration of follow-up was 60 weeks. Any patient who experienced reactivation would start treatment with Baraclude (entecavir, Teva Pharmaceutical Industries) as soon as it was detected.

Overall, 14 patients developed reactivation after a median of 40 weeks of which 13 patients (92.8%) remained HBsAg-negative at reactivation. The median HBV DNA level at reactivation was 25.9 IU/mL.

Researchers used the Kaplan-Meier method to determine the 2-year cumulative HBV reactivation rate, which was 35.1% among this cohort. Entecavir therapy was effective in controlling HBV reactivation for all patients who experienced it, according to the presentation.

The patients with acute or chronic graft-versus-host-disease (GVHD) had a higher 2-year rate of HBV reactivation compared with patients without GVHD (acute GVHD: 65.4% versus 24.1%, P = .049; chronic GVHD: 80.2% versus 23.0%, P = .001), respectively. Multivariate analysis showed chronic GVHD and age 50 years or older to be independently associated with reactivation (HR = 7.6; 95% CI, 2.2-26.3; P = .001; and HR=7.9, 95% CI 1.9-33.3, P = 0.004, respectively). No association was observed between HBV reactivation and anti-HBs status or donor serology (P > .05 for all). 

“There is a high cumulative rate of HBV reactivation in HBsAg-negative and anti-HBc-positive individuals undergoing HSCT,” Seto said during his presentation. “Chronic GVHD and age more than 50 years were independently associated with reactivation.” – by Melinda Stevens

For More Information:

Seto W-K. Abstract O009. Presented at: International Liver Congress; April 22-26, 2015; Vienna.

Disclosure: Ching-Lung Lai reports being a consultant and sponsoring lectures for BMS. Please see the abstract for a full list of authors’ relevant financial disclosures. 

Editor's note: This article has been updated with more accurate data. We regret this oversight.