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AIM: To investigate the timing, safety and efficacy of prophylactic antiviral therapy in patients with hepatitis B virus(HBV) infection undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT).METHODS: This prospective study recruited a total of 57 patients diagnosed with malignant hematological diseases and HBV infection at the First Affiliated Hospital of Sun Yat-sen University between 2006 and 2013.The patients were classified as hepatitis B surface antigen(HBs Ag)-positive or HBs Ag-negative/ anti HBcpositive.Patients were treated with chemotherapy followed by antiviral therapy with nucleoside analogues.Patients underwent allo-HSCT when serum HBV DNA was < 103 IU/mL.Following allo-HSCT, antiviral therapy was continued for 1 year after the discontinuation of immunosuppressive therapy.A total of 105 patients who underwent allo-HSCT and had no HBV infection were recruited as controls.The three groups were compared for incidence of graft-vs-host disease(GVHD), drug-induced liver injury, hepatic veno-occlusive disease, death and survival time.RESULTS: A total of 29 of the 41 subjects with chronic GVHD exhibited extensive involvement and 12 exhibited focal involvement.Ten of the 13 subjects with chronic GVHD in the HBs Ag(-)/hepatitis B core antibody(+) group exhibited extensive involvement and 3 exhibited focal involvement.Five of the 10 subjects with chronic GVHD in the HBs Ag(+) group exhibited extensive involvement and 5 exhibited focal involvement.The non HBV-infected group did not differ significantly from the HBs Ag-negative/anti HBc-positive and the HBs Ag-positive groups which were treated with nucleoside analogues in the incidence of graft-vs-host disease(acute GVHD; 37.1%, 46.9% and 40%, respectively; P = 0.614; chronic GVHD; 39%, 40.6% and 40%, respectively; P = 0.98), drug-induced liver injury(25.7%, 18.7% and 28%, respectively; P = 0.7),death(37.1%, 40.6% and 52%, respectively; P = 0.4) and survival times(P = 0.516).One patient developed HBV reactivation(HBs Ag-positivity) due to early discontinuation of antiviral therapy.CONCLUSION: Suppression of HBV DNA to < 103 IU/m L before transplantation, continued antiviral therapy and close monitoring of immune markers and HBV DNA after transplantation may assure the safety of alloHSCT.
AIM: To investigate the timing, safety and efficacy of prophylactic antiviral therapy in patients with hepatitis B virus (HBV) infection undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: This prospective study recruited a total of 57 patients diagnosed with malignant hematological diseases and HBV infection at the First Affiliated Hospital of Sun Yat-sen University between 2006 and 2013.The patients were classified as hepatitis B surface antigen (HBs Ag) -positive or HBs Ag-negative / anti HBcpositive. Patients were treated with chemotherapy followed by antiviral therapy with nucleoside analogues. Patients underwent allo-HSCT when serum HBV DNA was <103 IU / mL. After allo-HSCT, antiviral therapy was continued for 1 year after the discontinuation of immunosuppressive therapy. A total of 105 patients who underwent allo-HSCT and had no HBV infection were recruited as controls.The three groups were compared for for of graft-vs-host disease (GVHD), drug-indu ced liver injury, hepatic veno-occlusive disease, death and survival time. RESULTS: A total of 29 of the 41 subjects with chronic GVHD including extensive involvement and 12 showed a focal injury. Ten of the 13 subjects with chronic GVHD in the HBs Ag ( Fetal of the 10 subjects with chronic GVHD in the HBsAg (+) group rendered extensive involvement and 5 demonstrated focal involvement. the non HBV-infected group did not differ significantly from the HBs Ag-negative / anti HBc-positive and the HBs Ag-positive groups which were treated with nucleoside analogues in the incidence of graft-vs-host disease (acute GVHD; 37.1%, 46.9% and 40 %, respectively; P = 0.614; chronic GVHD; 39%, 40.6% and 40%, respectively; P = 0.98) (37.1%, 40.6% and 52%, respectively; P = 0.4) and survival times (P = 0.516) .One patient developedHBV reactivation (HBs Ag-positivity) due to early discontinuation of antiviral therapy. CONCLUSION: Suppression of HBV DNA to <103 IU / m L before transplantation, continued antiviral therapy and close monitoring of immune markers and HBV DNA after transplantation may assure the safety of alloHSCT.