A possible role for lamivudine as prophylaxis against hepatitis B reactivation in carriers of hepatitis B who undergo chemotherapy and autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma

Endo, Tomoyuki; Sakai, Tomomi; Fujimoto, Katsuya; Yamamoto, Satoshi; Takashima, H; Haseyama, Yoshihito; Nishio, Mitsufumi; Koizumi, Kazuki; Koike, Takao; Sawada, Kenichi

doi:10.1038/sj.bmt.1702804

Cited by 38 publications

(27 citation statements)

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“…Administration of chemotherapy to patients with malignancies who are also carriers of HBV, by means of the subsequent immunosuppression, promotes viral replication and infection of a substantial number of hepatocytes. After the withdrawal of chemotherapy, partial recovery of cytotoxic T-cell-mediated immune response causes rapid destruction of the infected hepatocytes [20]. This complication has been well known for over 25 years and poses a major risk for these patients, with varying morbidity and mortality rates [1,2,17,[28][29][30][31][32].…”

Section: Reactivation Of Hepatitis B In Patients With Chronicmentioning

confidence: 99%

“…This complication has been well known for over 25 years and poses a major risk for these patients, with varying morbidity and mortality rates [1,2,17,[28][29][30][31][32]. The severity of the subsequent liver damage cannot be predicted and may range from slight elevation of aminotransferases to fatal fulminant hepatitis [13,20,33].…”

Section: Reactivation Of Hepatitis B In Patients With Chronicmentioning

confidence: 99%

“…It has been proposed that these patients be treated with reduced-intensity chemotherapy, but the risk of flare-up still exists and the likelihood of remission is obviously diminished [13]. Some suggest the administration of steroid-free chemotherapy, but these regimens are considered suboptimal and hepatitis exacerbation can develop even in these patients [20,23,35]. Interferon has been used in a few cases, but is often prematurely withdrawn because of its hematologic toxicity.…”

Section: Reactivation Of Hepatitis B In Patients With Chronicmentioning

confidence: 99%

“…It is well tolerated and has little if any hematologic toxicity [13,[15][16][17]. It has been shown to be effective in the management of chemotherapy-induced HBV reactivation in patients with hematologic malignancies; nevertheless, mortality rates might still be high if treatment is delayed or if there is already a high viral load in the liver [7,11,13,[18][19][20]. When lamivudine is given prior to chemotherapy, it prevents the HBV replication during the immunosuppression period, and thus might reduce the risk of hepatitis B exacerbation.…”

Section: Introductionmentioning

confidence: 99%

“…When lamivudine is given prior to chemotherapy, it prevents the HBV replication during the immunosuppression period, and thus might reduce the risk of hepatitis B exacerbation. However, there are only a few reports about the prophylactic administration of lamivudine in this setting [7,8,[20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Prevention of hepatitis B reactivation with lamivudine in hepatitis B virus carriers with hematologic malignancies treated with chemotherapy—A prospective case series

et al. 2005

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Administration of immunosuppressive treatment in hepatitis B virus carriers with malignancies is associated with the risk of hepatitis B reactivation. This complication is more frequent in patients with hematologic malignancies because administration of corticosteroids, the mainstay of treatment of these patients, is an independent risk factor for hepatitis B reactivation. When lamivudine is given prior to chemotherapy, it prevents the viral replication during the immunosuppression period; therefore, it might reduce the risk of hepatitis B exacerbation. We performed a prospective study to assess the efficacy of prophylactic administration of lamivudine in this setting. Ten hepatitis B virus carriers with hematologic malignancies were included in this study; seven were HBsAg positive, and three had isolated antiHBc and detectable HBV-DNA levels. Nine patients were given corticosteroids after the administration of lamivudine. Lamivudine was given per os at a dose of 100 mg once daily. In four patients that had not been previously treated with chemotherapy, lamivudine was started 19 days (median) (range, 0-35 days) prior to the onset of chemotherapy. The administration of lamivudine has not stopped since in any of our patients. After a median follow-up of 15 months (range 6-38 months), no hepatitis B reactivation was observed. HBV-DNA levels were decreased in all 6 patients who had detectable HBV-DNA at baseline. Lamivudine was well tolerated. Chemotherapy regimens were administered as planned, and their effectiveness was not compromised by lamivudine. In conclusion, prophylactic administration of lamivudine should be considered as a means of reducing the frequency of hepatitis B reactivation in hepatitis B virus carriers with hematologic malignancies who are being treated with chemotherapy. Am.

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