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

Abstract

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...

Lamivudine treatment for acute hepatitis B virus infection during allogeneic peripheral blood stem cell transplantation

“…3,4 This drug has also been used sporadically to prevent viral reactivation in HBsAg carriers and in patients with anti-HBs antibodies (Abs) receiving prolonged immunosuppressive therapy 5 or undergoing bone marrow transplantation. [6][7][8][9] We report on the use of lamivudine to treat acute HBV infection, which presented during the conditioning for allogeneic stem cell transplantation. The patient was a 34-year-old woman with acute myeloblastic leukemia -M2, diagnosed in June 2001.…”