Molecular Screening for Hepatitis B and Hepatitis C Viruses in Allogeneic Hematopoietic Stem Cell Transplantation– a Pilot Study

Viral hepatitis is, despite graft versus host disease (GVHD) and veno-occlusive disease (VOD), the third cause of hepatic complications after allogeneic hematopoietic stem cell transplantation (alloHSCT). The aim of this study was to analyze the effectiveness of molecular screening for hepatotropic viruses: hepatitis B virus (HBV) and hepatitis C virus (HCV), basing on a single centre experience.

We have evaluated 30 pts (15 women, 15 men), median age 33.5 years (18–61), who underwent alloHSCT from HLA-identical sibling (7) or unrelated donors (23) in years 2011–2012. The stem cell source was peripheral blood in all pts. Indication for allo-HSCT was: AML(11pts), ALL (10pts), OMF (4pts), SAA(2pts), PNH (2pt) and CML(1pt). Preparative regimen was myeloablative in 20pts (BuCy:10pts, Cy+TBI:10pts) and reduced in 10pts (Flu+Bu:5pts, Treo+Flu:3pts, Treo+Cy:1pt, Flu+Cy:1pt). Standard GVHD prophylaxis consisted of cyclosporine, methotrexate and pre-transplant anti-thymocyte globulin (in 28pts). Molecular quantitative polymerase chain reaction (QPCR) HBV-DNA and HCV-RNA tests and screening for serological markers of HBV (HBc-Ab, HBs-Ab, HBs-Ag, HBe-Ab, HBe-Ag) and HCV (HCV-Ab) infection were performed at four time-points (before the start of conditioning treatment and on days +28, +100 and +180 post-transplant).

HBc-Ab was initially positive in 2 pts, who presented negative results of other serological markers and molecular tests. In remaining 28 pts all serological and molecular markers were negative. No pt developed hepatitis infection and/or reactivated virus replication. Both pts who were initially HBc-positive did not develop any markers of HBV reactivation after one year observation, despite the intensive immunosuppression.

Outcomes of our pilot study do not justify the routine molecular screening of hepatotropic viruses in patients undergoing alloHSCT, despite the profound immunosuppression. The routine molecular screening should be reserved only for patients with positive serological markers or/and those with symptoms of hepatitis.

No relevant conflicts of interest to declare.