Patients with resolved Hepatitis B virus (HBV) infections are at a high risk of HBV reactivation and de novo HBV infection after allogeneic stem cell transplantation; therefore, it is important to carefully monitor HBV serological markers in these patients.
A 39-year-old man diagnosed with myelodysplastic syndrome and refractory anemia with excess blasts (RAEB-1), received a peripheral blood stem cell transplant from an HLA-matched sibling. The patient had latent HBV infection, while his donor had no history of HBV infection. Twelve months after the transplant, the patient tested negative for HBsAb and he received entecavir (ETV) as prophylaxis for HBV recurrence. Cyclosporine was discontinued 15 months after transplantation. ETV was discontinued after 10 months of treatment because serum HBV-DNA was not detected. Moreover, 2 years after the transplant, the patient underwent HBV vaccination. However, HBV reactivation occurred 29 months post-transplantation, and ETV was readministered. Two months after starting ETV treatment, HBV-DNA was not detected but 4 months later, re-seroconversion occurred and the patient tested positive for HBsAb.
This case suggests that serological HBV markers should be monitored carefully in patients with resolved HBV infections who received allogeneic stem cell transplants. HBV vaccination is recommended for these patients after immunosuppressive medication is discontinued.
2017 The Japan Society for Hematopoietic Stem Cell Transplantation