Lamivudine allows completion of chemotherapy in lymphoma patients with hepatitis B reactivation

Abstract

Reactivation of hepatitis B virus in patients receiving chemotherapy for non-Hodgkin's lymphoma (NHL) may give rise to hepatitis, hepatic failure and death, and prevent further chemotherapy. We report four patients with NHL in whom hepatitis flare-up was observed after two (three patients) and six (one patient) cycles of chemotherapy. After spontaneous recovery, they were treated with Lamivudine (100 mg/day), which enabled completion of chemotherapy without further hepatitis B reactivation. In one patient, high-dose chemotherapy and autologous stem cell transplantation was also performed. These data suggest a possible role for Lamivudine in preventing hepatitis B reactivation during chemotherapy administration to chronic carriers of the hepatitis B virus. Moreover, it enabled the completion of both standard and high-dose chemotherapy in patients with previous hepatitis B reactivation.

Lamivudine prophylaxis reduces the incidence and severity of hepatitis in hepatitis B virus carriers who receive chemotherapy for lymphoma

“…Based on other reports, it has been shown that the continuation of lamivudine for 1-6 months after chemotherapy is equally effective in reducing viral reactivation. [17][18][19]25 Because the patients in the current study had different pathologic subtypes of lymphoma, and because patients in the lamivudine group had a relatively short follow-up, improvements in survival were not observed. However, prophylactic lamivudine treatments allowed more patients with lymphoma to receive adequate cytotoxic chemotherapy, and it would be reasonable to predict an increased survival advantage.…”

“…16 The use of prophylactic lamivudine in patients with lymphoma who were receiving chemotherapy recently was reported in several small, retrospective studies. [17][18][19][20] Lee et al 21 reported a retrospective case-control study that compared 20 HBsAgpositive patients who received prophylactic lamivudine during chemotherapy with a group of 11 matched controls. Their results indicated that 17 patients (85%) patients in the controls group and 1 patient (9%) patient in the prophylactic group had hepatitis due to reactivation of HBV.…”

Screening for Hepatitis B Surface Antigen before Chemotherapy: Current Practice and Opportunities for Improvement

“…The potential clinical consequences of hbv reactivation include liver damage from reactivation hepatitis, interruption of cancer treatment, and a mortality rate of up to 5% 7 . Prophylaxis with anti-hbv nucleoside/nucleotide analogs such as lamivudine reduces the incidence and severity of reactivation hepatitis in hbv carriers receiving chemotherapy [8][9][10][11][12] .…”

Hepatitis B Reactivation and Rituximab in the Oncology Practice

“…In addition to rituximab use, risk factors for HBV reactivation in oncology patients include male sex, use of anthracyclines, corticosteroid treatment, hepatitis B e antigen (HBeAg) seropositivity, and pre-existing abnormalities in liver function tests (Table 4) [12]. Hepatic flare can consequently lead to interruptions in delivering curative chemotherapy, lasting as long as 100 days [33]. Such delays in chemotherapy may result in a decreased disease-free and overall survival [15].…”