Abstract
After allogeneic peripheral blood
stem cell transplantation (PBSCT), children are at high risk of
hepatitis B virus (HBV) infection because of the potential loss of HBV
immunity. The factors which can affect it are not fully understand. This
study aimed to assess the probability of hepatitis B surface antibody
(HBsAb) disappearance after PBSCT and to evaluate the impact of donor
and recipient immunity on HBsAb disappearance. A total of 110 patients
who underwent PBSCT between January 2016 and December 2018 and their
paired donors were retrospectively enrolled in this study. Before
transplantation, 87 (79.1%) patients were HBsAb seropositive, and 23
(20.9%) were HBsAb seronegative. Fifty-five (63.2%) patients with
protective HBsAb titers before PBSCT lost their HBV immunity within one
year after transplantation. Univariate analysis showed that the low
recipient pretransplant HBsAb titer, antithymocyte globulin (ATG)
administration, corticosteroid
administration and
graft-versus-host disease (GVHD)
were significant risk factors for HBsAb disappearance
(P <0.05). Multivariate analysis showed that only
recipient pretransplant HBsAb titers lower than 207.5 IU/L
(P =0.022, hazard ratio (HR ): 1.925, 95% confidence
interval (CI ): 1.101-3.367) and the presence of GVHD
(P =0.033, HR =1.921, 95% CI : 1.056-3.495) were risk
factors for HBsAb disappearance one year after HSCT. In conclusion, most
recipients lost previously acquired immunity to HBV after PBSCT. A high
titer of HBsAb in the recipient before transplantation had a protective
effect against posttransplant HBsAb disappearance, but the presence of
donor immunity did not significantly influence the maintenance of
recipient immunity to HBV.
Introduction
Allohematopoietic stem cell transplantation (allo-HSCT) has been
commonly employed to treat hematologic malignancies, serious or
refractory aplastic anemia and some congenital diseases. However, HSCT
results in secondary immune deficiency that lasts for 1-2 years,
including the loss of protective antibody levels against certain
vaccine-preventable diseases, which predisposes transplant recipients to
infections [1-5]. China remains one of the countries in the world
with a high prevalence of viral hepatitis B according to WHO data, which
estimates that approximately 86 million people in China are hepatitis B
surface antigen (HBsAg) carriers [6-8]. Therefore, after allo-HSCT,
children are at high risk of hepatitis B virus (HBV) infection due to
secondary immune dysfunction and the need for multiple blood
transfusions.
The primary objective of this study was to assess the probability of
hepatitis B surface antibody (HBsAb) disappearance in children after
allogeneic peripheral blood stem cell transplantation (PBSCT), and the
second was to evaluate the impact of donor and recipient immunity on
HBsAb disappearance.