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Hepatitis B viremia in a patient with documented previous HBV immunity after autologous transplantation of highly purified PBSC

Bone Marrow Transplantation volume 26, pages 114–115 (2000)Cite this article

In the December 1999 (1) issue of BMT, Senecal et al1 reported a patient with fatal acute hepatitis B after high-dose therapy and autologous stem cell transplantation (SCT). This case was interesting because prior to transplant, the patient had a documented immune response against HBV (anti-HBs positive, anti-HBc positive, HBsAG negative), suggesting protective immunity against HBV after resolved HBV infection. The authors concluded that the course in this patient provides evidence for the possibility of reactivation of dormant HBV in spite of a protective immune status under the conditions of severe immunosuppression. We would like to describe a similar case to emphasize that HBV reactivation after autologous SCT can be of some importance in particular in patients reconstituted with heavily lymphocyte-depleted autografts.

In March 1999, a 51-year-old man with advanced chronic lymphocytic leukemia (B-CLL) underwent myeloablative treatment with 12 Gy fractionated total body irradiation and cyclophosphamide 120 mg/kg, followed by reinfusion of autologous PBSC. The autograft had been depleted of both T cells and B cells by sequential positive and negative CD34+ cell selection as previously described.2 The residual T cell and B cell content of the inoculum was 0.26 and 0.31 × 103/kg, respectively. Previous cytotoxic treatment comprised six cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) and two cycles of Dexa-BEAM (dexamethasone, BCNU, etoposide, ara-C, melphalan). During the mobilization and transplant procedures, the patient received a total of 16 blood units (red cells and platelets) from HBV-negative volunteer donors. Immunoglobulins were not administered. Four months after as well as immediately prior to transplant, HBV serology showed HBsAg negative, anti-HBs positive, anti-HBc-IgG positive, anti-HBc-IgM negative, compatible with protective immunity after a previous HBV infection. The transplant procedure was well tolerated and the patient presented with complete remission of the B-CLL at 3 months post transplant. HBV serology had remained unchanged. Four months later, however, the patient still had normal transaminases but showed the serological pattern of active HBV infection: HBsAg positive, anti-HBs negative, HBV-DNA positive (1.05 × 108 copies/ml). A second analysis performed 2 weeks later yielded similar results. In December 1999, the patient was still alive and well without clinical or biochemical evidence of liver disease.

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References

  1. Senecal D, Pichon E, Dubois F et al. Acute hepatitis B after autologous stem cell transplantation in a man previously infected by hepatitis B virus Bone Marrow Transplant 1999 24: 1243–1244

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  2. Paulus U, Schmitz N, Viehmann K et al. Combined positive/negative selection for highly effective purging of PBPC grafts: towards clinical application in patients with B-CLL Bone Marrow Transplant 1997 20: 415–420

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Authors and Affiliations

  1. Department of Internal Medicine II, University of Kiel, Chemnitzstr. 33, Kiel, 24116, Germany

    P Dreger, M Kneba & N Schmitz

  2. Department of Medical Microbiology, University of Kiel, Chemnitzstr. 33, Kiel, 24116, Germany

    P Rautenberg

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  1. P Dreger
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  2. P Rautenberg
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  3. M Kneba
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  4. N Schmitz
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Dreger, P., Rautenberg, P., Kneba, M. et al. Hepatitis B viremia in a patient with documented previous HBV immunity after autologous transplantation of highly purified PBSC. Bone Marrow Transplant 26, 114–115 (2000). https://doi.org/10.1038/sj.bmt.1702455

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