REVERSE SEROCONVERSION OF HEPATITIS-B AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION - A RETROSPECTIVE STUDY OF 37 PATIENTS WITH PRETRANSPLANT ANTI-HBS AND ANTI-HBC

Background. Reverse seroconversion to hepatitis B virus (HBV), i.e., H BV reactivation in patients with pretransplant antibodies to hepatitis B surface antigen (anti-HBs) and to hepatitis B core antigen (anti-HB c), is rarely re-ported after allogeneic bone marrow transplantation. Methods. To determine this risk, we studied clinical outcome and serol ogical changes in 37 patients with pretransplant anti-HBs and anti-HBc . Results. In 33 cases, no change in HBV markers was observed in the p osttransplant period. In four cases, anti-HBs and anti-HBc were lost, and hepatitis B surface antigen, hepatitis B e antigen, and HBV DNA em erged together with acute hepatitis, after cessation of immunosuppress ion. The actuarial risk of reactivation in the 37 patients was 20.5% ( median follow-up 20 months). No reactivation occurred in patients with anti-HBs-positive donors. Conclusion. Although few cases of postallog eneic bone marrow transplantation reverse seroconversion to HBV have b een reported, this study demonstrates that the actuarial risk is relat ively high and suggests that donor vaccination might be proposed proph ylactically or that HBs-specific immunoglobulin infusions might be war ranted.