REACTIVATION OF HEPATITIS-B VIRUS IN 2 CHRONIC GVHD PATIENTS AFTER TRANSPLANT

We report two cases of hepatitis B virus reactivation following alloge neic bone marrow transplantation (BMT) for severe aplastic anemia and acute myelocytic leukemia. The presence of antibodies to HBsAg, HBeAg and HBcAg prior to transplant indicated previous infection with hepati tis B virus (HBV). These antibodies disappeared 2 and 4 months after t he onset of chronic graft versus host disease (GVHD) following immunos uppressive treatment, but HBsAg reappeared in their sera 6 and 10 mont hs later, respectively. This suggests that chronic GVHD and immunosupp ressive drugs can reactivate HBV in HBsAb-positive patients, most like ly because of the decrease in quality and function of helper T cells a nd B cells during chronic GVHD to induce clearance of HBV antibodies a nd reactivation of HBV. Our observation confirms that patients with HB sAb, HBeAb and HBcAb present in their sera should not be considered to have 'immunity' to HBV after BMT.