Fulminant hepatitis is significantly increased in hepatitis B carriers after allogeneic bone marrow transplantation

Background. Bone marrow transplantation (BMT) is effective treatment for ma ny hematologic disease, but performed in a population with a high endemic h epatitis B virus carrier rate, the incidence of liver function impairment a nd fulminant hepatitis (FH) is expected to be raised. Methods. Forty three hepatitis B virus carriers received high-dose chemothe rapy and BMT, 32 patients received an allogeneic graft, and 11 patients aut ologous marrow. Acute graft-versus-host disease prophylaxis consisted of me thotrexate on day 1, 3, 6, and 11 and cyclosporine for B months. Results. After a median follow-up period of 68 months (range: 1-11.5 years) , 26 (81.3%) allogeneic BMT patients developed impaired liver function (LF) , 5 progressed to FH on day 93, 169, 170, 180, and 468, respectively, and d ied after an average of 13.8 days (range: 1-45 days). Whereas only 4 (36.4% ) autologous BMT patients developed impaired LF, and none FH, Impaired LF ( P=0.026, chi-square), and FH (odds ratio=12.86, P=0.009 for coefficient) we re significantly related to an allogeneic marrow graft, and the timing of l iver function impairment coincided with cyclosporine withdrawal. Hepatitis B surface antigen (HbsAg) disappeared from the serum in 4/14(28.6%) patient s receiving a marrow graft from an HbsAg+ donor, HbsAg was not detected in the serum after BMT in 2/11 (18.2%) autologous BMT patients. Conclusions. Hepatitis B virus carriers receiving a marrow graft from an Hb sAg+ donor have a significantly increased risk of FH.