Successful treatment with lamivudine for fulminant reactivated hepatitis B infection following intensive therapy for high-grade non-Hodgkin’s lymphoma

Abstract

Chronic carriers of Hepatitis B virus (HBV) infection, who are treated for malignant lymphoma, are at high risk of mortality from reactivated HBV infection. We report a case of a 29-year-old male chronic HBV carrier who developed fulminant reactivated HBV infection following intensive chemotherapy for stage IVB large cell B-cell non-Hodgkin's lymphoma associated with extensive central nervous system and bone marrow involvement. Prior to chemotherapy the patient had normal liver function tests and was negative for HBV DNA by semiquantitative PCR assay. Fulminant HBV reactivation was confirmed following clinical deterioration, massive rises in hepatic transaminases (peak alanine aminotransferase = 2,850 U/l), liver biopsy and rising levels of serum HBV DNA. Following treatment with lamivudine 150 mg bd for 18 weeks dramatic and sustained recovery ensued. Symptoms and liver function tests improved within days and HBV DNA became negative within 12 weeks. Our patient later died from relapsed lymphoma but without evidence of reactivated HBV infection. We advise that lamivudine should be considered during intensive chemotherapy treatment of chronic carriers of HBV.

Hepatitis B reactivation after chemotherapy: two decades of clinical research

“…With the increasing prevalence of HIV infection, HBV reactivation has also been observed in HBV-infected subjects with advanced immune deficiency due to HIV infection [22][23][24][25][26][27]. Hepatitis due to HBV reactivation has not only been reported in HBsAg-positive patients, HBeAg-positive [6,[28][29][30] or HBeAg-negative [31][32][33][34][35][36][37][38][39][40][41] subjects who were treated with chemotherapy and transplantation but also in HBsAg-negative patients who had past HBV infection (hepatitis B surface antibody; antiHBs positive and hepatitis B core antibody; anti-HBc positive) [42][43][44][45][46][47][48][49], especially those treated with rituximab or alemtuzumab-containing chemotherapy [50][51][52][53][54][55].…”

“…As hepatitis due to HBV virological reactivation is associated or preceded by enhanced HBV viral replication during the immunosuppressive phase, the initiation of antiviral treatment such as lamivudine [102][103][104][105][106][107][108][109] and famciclovir [84,110] (Table 2). A meta-analysis of these 13 studies with 702 HBsAg-positive patients (237 treated with preemptive lamivudine and 465 untreated controls), showed that the incidence of hepatitis due to HBV reactivation was 3.3% in the treated group and 35.0% in the untreated control group (odds ratio [OR]: 0.083; 95% CI: 0.045-0.155, P \ 0.0001).…”

Lamivudine therapy for a hepatitis B surface antigen (HBsAg)-positive leukemia patient receiving myeloablative chemotherapy and autologous stem cell transplantation

“…It has also recently been reported that this drug is also useful for the treatment of viral hepatitis after cytotoxic therapy. 8,9 In the present patient lamivudine appeared to work to not only avoid HBV exacerbation during transplantation, but also to treat reactivation of HBV later.…”

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

“…Recently, lamivudine has been successfully used in this setting, but experience is limited [11,13,18,19]. Some suggest that prompt diagnosis of hepatitis B exacerbation and early commencement of lamivudine therapy will decrease morbidity and mortality.…”

“…The administration of more intensive chemotherapy in order to treat the non-responders also increases the frequency of hepatitis B flare-up [1,11].…”