Revaccination Response and Lack of Hepatitis B Reactivation After HCT for Sickle Cell Disease.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-09-11 DOI:10.1111/tid.70097

Henna Butt, Neal Jeffries, Triscia Martin, Valeria De Giorgi, Alison Zamora, John F Tisdale, Matthew M Hsieh

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引用次数: 0

Abstract

Background: Sickle cell disease (SCD) can be cured by hematopoietic cell transplantation (HCT), but patients face increased risk of hepatitis B virus (HBV) reactivation due to immunosuppression. Understanding hepatitis B surface antibody (anti-HBs) kinetics is essential for optimizing HBV revaccination and posttransplant care.

Methods: This post hoc analysis examined HBV immunity, reactivation, and revaccination response in 71 SCD patients who underwent HCT at the National Heart, Lung, and Blood Institute (2008-2021) using alemtuzumab and low-dose total body irradiation.

Results: At baseline, 55% showed HBV immunity (anti-HBs ≥ 12 mIU/mL). Most patients responded to revaccination regardless of baseline immunity. Post-HCT revaccination was given to 93%, with 89% completing full series (Heplisav-B or Engerix-B). Vaccinated patients had a 67.5% chance of increased anti-HBs titers between Years 1 and 2, though no significant difference was seen compared to unvaccinated patients (p = 0.12). No HBV reactivation occurred; two patients with baseline HBcAb and HBsAg positivity showed decreasing HBV DNA levels.

Conclusions: Results indicate that HBV immunity can decline post-HCT, but most patients remain immune, and revaccination is effective. However, some non-responders-especially those treated with IVIG, rituximab, or prolonged immunosuppression-need further study. Prospective research is needed to optimize revaccination timing and immune monitoring in this high-risk group.

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镰状细胞病HCT后的再接种反应和乙型肝炎再激活缺失

背景：镰状细胞病（SCD）可以通过造血细胞移植（HCT）治愈，但由于免疫抑制，患者面临乙型肝炎病毒（HBV）再激活的风险增加。了解乙型肝炎表面抗体（anti-HBs）动力学对于优化HBV再接种和移植后护理至关重要。方法：这项事后分析检查了在国家心肺血液研究所（2008-2021）使用阿仑单抗和低剂量全身照射接受HCT的71例SCD患者的HBV免疫、再激活和再接种反应。结果：基线时，55%的患者表现出HBV免疫（抗HBV≥12 mIU/mL）。大多数患者对重新接种疫苗有反应，无论基线免疫情况如何。93%的患者在hct后再次接种疫苗，89%的患者完成了全套疫苗接种（Heplisav-B或Engerix-B）。接种疫苗的患者在第1年和第2年之间有67.5%的机会增加抗hbs滴度，尽管与未接种疫苗的患者相比没有显着差异（p = 0.12）。未发生HBV再活化；2例HBcAb和HBsAg基线阳性患者HBV DNA水平下降。结论：hct后乙肝病毒免疫力下降，但大多数患者仍保持免疫，再次接种是有效的。然而，一些无应答者，特别是那些用IVIG、利妥昔单抗或长期免疫抑制治疗的患者，需要进一步研究。需要前瞻性研究来优化这一高危人群的再接种时间和免疫监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.