Abstract:

BACKGROUND: Hematopathy patients carrying hepatitis virus would present problems such as hepatitis virus resistance to nucleoside analogue drugs or targeted therapy of hepatitis C virus when undergoing allogeneic hematopoietic stem cell transplantation (Allo-HSCT).

OBJECTIVE: To investigate the prophylaxis of hepatitis virus reactivation in patients undergoing Allo-HSCT.

METHODS: Five leukemia patients with HBV or HCV infection undergoing Allo-HSCT at the Hennan Provincial People’s Hospital from January 2005 to July 2008 were collected. The infused number of mononuclear cells was (8.6-19.3) ×10⁸/kg, with (5.1-15.4) ×10⁶/kg CD34⁺ cells. Case 1 received lamivudine treatment at the beginning of remission induction chemotherapy, and entecavir was added after 7 months. When the number of hepatitis B DNA copies was reduced to 1.02×10³ U/mL at 3 months after operation, and received a second transplantation due to leukemia relapse. Case 2 was treated by imatinib mesylate+lamivudine, transplanted when the number of hepatitis B DNA copies was under 1.0×10³ U/mL after 2 months. Case 3 was treated by lamivudine at the beginning of remission induction chemotherapy, followed by consolidation chemotherapy and transplantation when the number of hepatitis B DNA copies was under 1.0×10³ U/mL after 10 weeks. Case 4 was transplanted at the CR1 phase, and the lamivudine was applied at 1 day before transplantation. Case 5 were transplanted at the CR1 phase. The virus replication and hepatic functional status were detected in all patients.

RESULTS AND CONCLUSION: All cases were followed-up for 9 months. All patients rebuilt hematopoietic function, no venous occlusive disease, virus replication, or hepatic function damage occurred. The medication was stopped after 6 months in case 1, at 8 months in case 2, and at 6 months in case 3 and case 4. The number of hepatitis B DNA copies was persistently under 1.0×10³ U/mL in case 4, and the number of hepatitis C DNA copies was persistently under 1.0×10³ U/mL in case 5. Lamivudine could prevent hepatitis B reactivation in patients undergoing Allo-HSCT, and entecavir is still valid if the result is unsatisfactory.