Prevention of hepatitis B flare-up during chemotherapy using lamivudine: case report and review of the literature

Al-Taie, Oliver; Mörk, Hubert; Gassel, A. M.; Wilhelm, Martin; Weißbrich, Benedikt; Scheurlen, Michael

doi:10.1007/s002770050510

Cited by 65 publications

(44 citation statements)

References 18 publications

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“…95 Lamivudine has also been claimed to be effective in controlling viral replication during HBV reactivation, 79,101,102 thereby allowing individual patients to continue cytotoxic chemotherapy upon maintenance of a sufficient hepatic function. 102,103 Sustained HBeAg seroconversion and undetectable serum HBV DNA level for at least 3 months after the discontinuation of lamivudine therapy have also been observed in some patients who were initially HBeAg-seropositive, 103 and the postulated mechanism has been a high immune response to HBV reactivation that allows elimination of covalently closed circular DNA in hepatocytes in conjunction with suppression of viral replication. Lamivudine has also been reported to be effective in cases of hepatic decompensation during HBV reactivation 94,104 and in cases that involve a precore HBV mutant.…”

Section: Management Of Established Hbv Reactivationmentioning

confidence: 99%

Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy

2006

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It is estimated conservatively that more than one third of the world's population has been infected with the hepatitis B virus (HBV) and that there are 350 million people with chronic infection, 75% of whom live in Southeast Asia and the Western Pacific regions. [1][2][3] Reactivation of HBV infection is now a well-recognized complication in infected patients who undergo cytotoxic chemotherapy for cancer. The condition ranges from asymptomatic self-limiting anicteric hepatitis to severe, potentially fatal progressive decompensated hepatitis. With the increasing use of potent cytotoxic chemotherapy, reactivation of hepatitis B in endemic regions is becoming a common clinical problem. This adversely affects advances made in various forms of cancer therapy. In this review, we consider the diagnosis, prevention, and management of HBV reactivation in association with chemotherapy and hematopoietic stem cell transplantation, particularly in light of the availability of effective prophylactic antiviral therapy.Reactivation of HBV was first described by Wands et al., 4 who in 1975 reported the condition in 20 patients with lympho-and myeloproliferative disorders. Most of the cases reported since were similar in patients with hematological malignancies-in particular, lymphomas. [4][5][6][7][8][9][10][11][12][13][14][15][16] The skewed observations may be due to the fact that these patients are often subjected to intense myelosuppressive treatment regimens, the malignancies per se are often associated with an immunocompromised state, and the patients have been consistently reported to have a higher rate of hepatitis B surface antigen (HBsAg) seropositivity than the normal population. 9,[17][18][19] Over the past decade, HBV reactivation has been increasingly observed in patients with solid tumors. [18][19][20][21][22] In patients with hepatocellular carcinoma (85% of whom have chronic HBV infection in Southern China 3,23 ), hepatitis following systemic chemotherapy has been reported in 60% 20,24 ; this is mostly attributed to HBV reactivation, which has a 30% mortality rate. 20 In other cancer subpopulations, the incidence of HBV reactivation ranges between 25% and 40%. 10,15,18,21,25 In the setting of hematopoietic stem cell transplantation (HSCT) for various hematological and oncological conditions, HBV reactivation has been reported in over 50% of patients. [26][27][28] This is related to the intense chemotherapy with or without total body irradiation, and the coexistence of acute graft-versus-host disease. 28 Although the frequency of viral reactivation among HBsAg-positive patients with cancer would be expected to be the same irrespective of geographical area, the prevalence of HBV infection varies between different populations from 10% to 25% in endemic areas to less than 1% in others. 3,10,29 As a result, there would be proportional difference in the incidence of viral reactivation in a given population. Definitions and DiagnosisIn early reports, the diagnosis of HBV reactivation was based on HBsAg and hepatitis B ...

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Section: Management Of Established Hbv Reactivationmentioning

confidence: 99%

Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy

2006

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“…A series of patients receiving immunosuppression for bone marrow transplant demonstrated markedly low rates of reactivation without adverse effects of prophylaxis with lamivudine. 41,[65][66][67] The first case series of primary prophylaxis was published in 2001 involving 20 patients with haematological malignancies and a variety of chemotherapy regimens, the majority of which also included glucocorticoids. 42 With a rate of HBV reactivation of 5%, the role of lamivudine for prophylaxis among HBsAg carriers appeared to be indicated.…”

Section: Hbv Reactivationmentioning

confidence: 99%

“…61,87 As expected, when lamivudine was used as prophylaxis rather than for treatment of HBV, it also displayed a benign side effect profile. 31,42,44,47,65,76,79 A major clinical concern regarding prophylactic therapy with lamivudine, and an area of substantial controversy, is development of lamivudine-resistant mutant strains of HBV. 58,68,88 Evidence originally was based on case series of HBV infection treated with lamivudine for >1 year.…”

Section: 10mentioning

confidence: 99%

Systematic review: lamivudine prophylaxis for chemotherapy‐induced reactivation of chronic hepatitis B virus infection

Kohrt

Ouyang

Keeffe

2006

Aliment Pharmacol Ther

113

107

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“…Administration of lamivudine to the donor before the bone marrow harvest may be the easiest way to reduce HBV in harvested marrow; however, there may be a high risk of a rebound increase in HBV after cessation of lamivudine. 8,9 Since it is still uncertain how long the treatment should be maintained, it is better not to administer lamivudine to an HBVpositive carrier in order to avoid a possible rebound effect. Therefore, in vivo purging with lamivudine in the host after transplantation may be ethically the best way to eradicate HBV.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Several studies have shown the effectiveness of lamivudine for inhibition of HBV reactivation and for clinical and pathological improvement in hepatic dysfunction even in patients with hematological diseases after stem cell transplantation. 7,8 Here, we report a successful allogeneic BMT from an HBV-positive sibling donor (HBV carrier) into a patient with severe aplastic anemia complicated by chronic hepatitis B, using lamivudine. …”

mentioning

confidence: 99%

Successful allogeneic bone marrow transplantation from an HBV-positive donor into an HBV-positive recipient using lamivudine

Hashino

Takahata

Nozawa

et al. 2002

Bone Marrow Transplant

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Summary:A 21-year-old woman with severe aplastic anemia underwent allogeneic bone marrow transplantation from an HLA-identical sibling donor. The patient also had chronic hepatitis B and the donor was an HBV carrier. To decrease HBV and improve hepatic dysfunction before BMT, the patient had received lamivudine for 6 months. After marrow transfusion, administration of lamivudine was continued to inhibit replication of donor-derived HBV. The patient showed hematological engraftment on day 13 without any serious liver dysfunction. Eight months after BMT, she is now alive and well without chronic liver GVHD or reactivation of hepatitis B. HBV-DNA was not detected in the patient's serum. Administration of lamivudine to a BMT recipient with chronic hepatitis B may be a safe and promising way to prevent fatal liver dysfunction in the setting of allogeneic BMT, even in the event of BMT from an HBV-positive donor. Bone Marrow Transplantation (2002) 29, 269-271. DOI: 10.1038/sj/bmt/1703350 Keywords: allogeneic bone marrow transplantation; hepatitis B virus; lamivudine Allogeneic BMT has become one of the most effective treatment modalities for patients with hematological diseases. However, myeloablative and immunosuppressive conditioning, acute and chronic GVHD, and administration of immunosuppressive drugs for prophylaxis and treatment of GVHD enhance viral replication with a consequent increase in viral carriers. Reactivation of hepatitis B virus (HBV) infection after allogeneic BMT is well known in carriers. 1 Although hepatitis B surface antigen (HBsAg) positivity in the recipient is not generally considered to be a strict contraindication for BMT, patients with chronic HBV infection have a high risk of severe hepatic failure, leading to fulminant hepatitis with a fatal outcome, after transplantation due to reactivation of HBV. 2,3 Moreover, the use of HBsAg-positive donors, particularly if hepatitis B e antibody (anti-HBe) positive, has been shown to increase the risk of severe liver disease in BMT recipients, and hepatitis B surface antibody (anti-HBs) positivity has been shown to prevent severe liver damage. 4 Recently, lamivudine, which is one of the reverse transcriptase inhibitors of human immunodeficiency virus (HIV) and has been used to treat patients with HIV infection, has been administered to patients with chronic hepatitis B. 5,6 Several studies have shown the effectiveness of lamivudine for inhibition of HBV reactivation and for clinical and pathological improvement in hepatic dysfunction even in patients with hematological diseases after stem cell transplantation. 7,8 Here, we report a successful allogeneic BMT from an HBV-positive sibling donor (HBV carrier) into a patient with severe aplastic anemia complicated by chronic hepatitis B, using lamivudine. Case reportIn October 1996, a 21-year-old woman was diagnosed with severe aplastic anemia. She was treated with a combination of cyclosporin A, anti-thymocyte globulin (ATG), and granulocyte colony-stimulating factors, but her pancytopenia did not impro...

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Prevention of hepatitis B flare-up during chemotherapy using lamivudine: case report and review of the literature

Cited by 65 publications

References 18 publications

Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy

Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy

Systematic review: lamivudine prophylaxis for chemotherapy‐induced reactivation of chronic hepatitis B virus infection

Successful allogeneic bone marrow transplantation from an HBV-positive donor into an HBV-positive recipient using lamivudine

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