A prophylactic approach for bone marrow transplantation from a hepatitis B surface antigen-positive donor |
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Authors: | Sobhonslidsuk Abhasnee Ungkanont Artit |
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Institution: | Department of Medicine,Faculty of Medicine,Ramathibodi Hospital,Mahidol University,Bangkok,Thailand |
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Abstract: | It has been accepted that bone marrow transplantation (BMT)is the only curative therapeutic option for certain hematologic malignancies.The southeast Asia region is an endemic area of hepatitis B virus(HBV)infection;thus,BMT using a hepatitis B surface antigen(HBsAg)-positive donor is occasionally unavoidable.Organ transplantation using a HBsAg-positive donor can lead to post-transplantation de novo HBV infection and severe HBV-related hepatitis if no effective prophylactic measures are taken prior to and after transplantation.In this report,a four-level approach was designed for a patient with chronic myeloid leukemia,beginning with a booster HBV vaccination before performing BMT with a HBsAg-positive donor.Prior to BMT,the HBV viral load of the donor was reduced to an undetectable level by antiviral therapy.After BMT,hepatitis B immunoglobulin was administered intramuscularly for 1 wk together with a long-term antiviral drug,lamivudine.One year after discontinuation of lamivudine,the patient is still free of HBV infection. |
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Keywords: | Bone marrow transplantation Hepatitis B virus Vaccination Hepatitis B immunoglobulin Lamivudine |
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