Prevention of hepatitis B reactivation with lamivudine in hepatitis B virus carriers with hematologic malignancies treated with chemotherapy

Th. Vassiliadis, Vassilia Garipidou, K. Tziomalos, V. Perifanis, Olga Giouleme, Sofia Vakalopoulou

Authors Th. Vassiliadis, Vassilia Garipidou, K. Tziomalos, V. Perifanis, Olga Giouleme, Sofia Vakalopoulou.

Abstract

SUMMARY
Background: 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.
Aim: To assess the efficacy of prophylactic administration
of lamivudine in this setting. Methodology: Ten hepatitis B
virus carriers with hematologic malignancies were included
in the 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 who 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 been stopped since in any of our patients. Results:
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 six patients who had detectable HBVDNA
at baseline. Lamivudine was well tolerated. Chemotherapy
regimens were administered as planned and their
effectiveness was not compromised by lamivudine. Conclusion:
Prophylactic administration of lamivudine is a safe
and effective method to reduce the frequency of hepatitis B
reactivation in hepatitis B virus carriers with hematologic
malignancies, who are being treated with chemotherapy.
Key words: chemotherapy, hematologic malignancies,
hepatitis B reactivation, lamivudine