期刊
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
卷 26, 期 9, 页码 1719-1728出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2020.05.004
关键词
Hematopoietic stem cell transplantation; HBsAg- positive donor; HBV-related hepatitis; Hepatitis B virus; Cost-effective
资金
- National Key Research and Development Program of China [2018YFA0107804]
- National Natural Science Foundation of China [81970158]
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 (R-2 = .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. (C) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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