Hepatitis B Immune Globulin Prophylaxis of Viral Reactivation during Stem Cell Transplant

Background

Stem cell transplant patients who are hepatitis B negative at the time of transplant and receive stem cells from a hepatitis positive donor have a higher risk of liver related post-transplant complications and hepatitis viral positivity.  The use of lamivudine has been documented in the literature as chemoprophylaxis for preventing viral reactivation in positive patients and also surface antigen negative patients receiving stem cell product from hepatitis positive donors.  The expected duration of chemoprophylaxis with lamivudine therapy is multiple months following stem cell transplant. This is a case series of using a two dose course of hepatitis B immune globulin, without lamivudine, for the prevention of viral seroconversion in stem cell transplant recipients. 

Methods

This is a single center retrospective chart review of three pediatric stem cell transplant patients who were prescribed Hepatitis B immune globulin for prophylaxis of seroconversion of  hepatitis B.  Hepatitis B immune globulin 0.06mL per kilogram was administered as two doses, on day -1 or day 0, and repeated four weeks later.   All patients received allogeneic transplantation from matched related donors, found to be positive for Hepatitis B prior to stem cell harvest.  Diagnoses for stem cell transplant of the patients were Acute Lymphoblastic Leukemia, Congenital Myelofibrosis and Cartilage Hair Hypoplasia.  Patient age ranged from 1 to 17 years. 

Results

At median of 20 months follow up (range 12-32 months), no patients were reported to have a positive hepatitis B DNA after stem cell transplant.  No cases of veno-oclusive disease of the liver were observed.  This small case series may present an alternative, simpler  prophylaxis regimen that is effective at preventing hepatitis viral transmission during stem cell transplant.