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2376 Changes of Hepatitis B Immune Status after Allogeneic Hematopoietic Stem Cell Transplantation in HBsAg Negative/Anti-Hbc Positive Patients: A Single Center Observational Study

Program: Oral and Poster Abstracts
Session: 721. Clinical Allogeneic Transplantation: Conditioning Regimens, Engraftment, and Acute Transplant Toxicities: Poster II
Sunday, December 6, 2020, 7:00 AM-3:30 PM

Jinhua Ren1*, Dabing Chen1*, Rong Zheng1*, Yu Zhang1*, Jingjing Xu1*, Xiaofeng Luo1*, Zhihong Zheng1*, Zhizhe Chen1*, Jianda Hu, MD, PhD2 and Ting Yang, MD, PhD3

1Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
2Fujian Medical University Union Hospital, Fuzhou, China
3Department of Hematology, Fujian Medical University Union Hospital,Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fuzhou, China


Low levels or lack of antibodies to the hepatitis B surface antigen (anti-HBsAg, respectively) have been associated with an increased risk of developing an hepatitis B virus (HBV) response in patients with resolved HBV infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Levels of HB core antibodies (anti-HBc) is a new marker associated with the natural history and treatment response of chronic HBV infection.


This study aims to determine whether different changes in anti-HBc and anti-HBs levels during allo-HSCT can predict the impact of HBV on the survival of patients who underwent allo-HSCT.


This prospective study enrolled 141 patients who underwent allo-HSCT at the Union Medical College Hospital of Fujian Medical University between 2013 and 2016. The cohort included 65 patients with acute myeloid leukemia, 25 with acute lymphoblastic leukemia, 7 with chronic myeloid leukemia, 15 with aplastic anemia, 5 with lymphoma, and 8 with myelodysplastic syndrome. Based on HBsAg and anti-HBc results, patients were classified as HBsAg-positive (n=16), HBsAg-negative/anti-HBc-positive (n=81), and HBsAg-negative/anti-HBc-negative (n=44). Hepatitis B serological markers (ELISA) and HBV DNA (PCR) were assayed before and every two weeks after HSCT. After transplant, patients received antiviral treatment with a nucleoside analog entecavir given before the transplantation. Antiviral therapy was continued for 1 year after stopping immunosuppressive therapy after transplantation. Death, overall survival (OS), incidence of graft-versus-host disease (GVHD), and drug-induced liver injury were compared among the three groups.


The three groups were well matched demographically. All patients achieved successful engraftment within one month post-transplant. There was no difference in time to leukocyte and platelet engraftment in the three groups. Comparing OS between the three groups, the two-year OS was 64.3% vs 53.5% vs 52.4%, respectively, with no significant difference (p=0.866). After allo-HSCT, 22/81 (27.1%)subjects in the HBsAg-negative/anti-HBc-positive group exhibited loss of anti-HBc at the median time 6 months(3-21m). The incidence of acute GVHD (46.9 % versus 40 %, P =0.163) was similar in the loss anti-HBc group (n=22) versus no-loss anti-HBc group (n=59). With a median follow-up time of 588 days (range: 46-1582 days), the incidence of liver injury in the two groups was similar (52.2% versus 46.5% p=0.633). The difference in the post-transplantation cumulative survival rates between the groups with loss of anti-HBc (n=22) and no-loss (n=59) was significant (83.3% versus 43.1%, P =0.001).


Loss of anti-HBc early in hematopoietic stem cell transplantation may help predict patient outcome.

Disclosures: No relevant conflicts of interest to declare.

*signifies non-member of ASH