Management strategy in aplastic anemia patients with HBV infection following intensive immunosuppressive therapy in Chinese cohort: prophylactic antiviral therapy may not be necessary with close monitoring.

PURPOSE: Acquired aplastic anemia (AA) results from bone marrow failure, and intensive immunosuppressive therapy (IST) is a standard treatment for AA. However, the elimination of lymphocytes may lead to the reactivation of hepatitis B virus (HBV) in patients with HBV infection, and whether to administer antiviral drugs for prevention remains uncertain.

METHODS

From May 2014 to July 2023, 137 AA patients who were treated with antithymocyte globulin plus Cyclosporin A were divided into three groups according to their HBV serologic status to estimate their safety and efficacy, as well as HBV reactivation.

RESULTS

Seven (5.11%) patients had chronic HBV infection; six of them received antiviral drugs and did not develop HBV reactivation, and one patient developed HBV reactivation due to personal refusal of treatment. For patients with resolved HBV infection (62, 45.26%) or HBV-uninfected patients (68, 49.64%), prophylactic antiviral treatment was not administered, and none of the patients developed HBV reactivation. HBV-uninfected patients achieved a partial response more rapidly (2.62 ± 4.24 vs 3.27 ± 5.23, P = 0.036), and univariate and multivariate analyses revealed that HBV infection (P = 0.037), infection within one month after IST (P = 0.034) were negatively correlated with treatment efficacy. Fifteen deaths occurred during the follow-up period, and HBV infection (P = 0.202) did not affect all-cause mortality.

CONCLUSION

Overall, AA patients with chronic HBV infection need to receive prophylactic antiviral drugs during IST, while stringent surveillance methods are necessary for patients with resolved HBV infection.