Allogeneic marrow transplantation in patients positive for hepatitis B
surface antigen
EC Reed, D Myerson, L Corey and JD Meyers
Program in Infectious Diseases, Fred Hutchinson Cancer Research Center,
Seattle, WA 98104.
Twenty patients who were positive for hepatitis B surface antigen (HBsAg)
underwent allogeneic marrow transplant for malignancy or other underlying
hematologic disease between 1975 and 1986. After transplant, one patient
had serologic evidence of hepatitis B virus (HBV) reactivation whereas
three patients had evidence of an immune response to HBV. Among four
patients with serologic follow-up of 1 year or more, three remained
positive for HBsAg and one became HBsAg negative. Six patients (30%)
developed clinical evidence of venocclusive disease and seven patients
(35%) developed acute graft-versus-host disease involving the liver, but
the incidence of these complications was similar to that expected among
patients who are not carriers of HBsAg. Three patients died with
hepatorenal failure, but all three had venocclusive disease and the
contribution of HBV infection to liver failure was unclear. Available liver
specimens obtained at autopsy (six patients) or biopsy (two patients) all
showed either HBsAg (one specimen) or hepatitis B core antigen (four
specimens) or both (three specimens) by immunoperoxidase staining. Although
HBV reactivation leading to hepatic failure has been reported among
allogeneic marrow transplant recipients as well as other immunocompromised
patients, we did not observe an increase in the incidence of severe liver
disease after transplant among these 20 patients positive for HBsAg at the
time of transplant, and do not consider positivity for HBsAg to be a
contraindication to allogeneic marrow transplantation.
Volume 77,
Issue 1,
pp. 195-200,
01/01/1991
Copyright © 1991 by The American Society of Hematology
