title: Preemptive use of interferon or lamivudine for hepatitis B reactivation in patients with aggressive lymphoma receiving chemotherapy.
abstract: The hepatitis B virus (HBV) reactivation rate among hepatitis B virus surface antigen (HBsAg)-positive patients undergoing chemotherapy ranges from 21 to 35% with a mortality rate of 4-41%. The risk is significantly evident in patients with aggressive lymphoma, which is highly responsive to standard chemotherapy with cyclophosphamide, hydroxydaunomycin, vincristine, and prednisone (CHOP) achieving a complete response rate of 60-80% and 5-year survival rate of 30-50% with only 1% of treatment-related mortality. Alpha-Interferon and lamivudine were given as preemptive treatment for HBV reactivation in HBsAg-positive patients treated for aggressive lymphoma consecutively from 1994 to 1997 and 1998 to 2001, respectively, in our institution. The outcome of 77 HBsAg-positive patients treated for aggressive lymphoma at our institution from 1990 to 2001 was studied. Of these patients, 53 did not receive prophylaxis while 13 received subcutaneous alpha-interferon 3 x 10(6) U thrice weekly and 11 received oral lamivudine 100 mg/day simultaneously with chemotherapy. Seventeen patients in the non-prophylactic group experienced HBV reactivation (32%), seven of whom progressed to fatal fulminant hepatitis (41%), which is associated with 13.2% of the mortality rate among the non-prophylactic patients. None of the 24 patients in the prophylactic group had grade III or IV toxicity or elevated ALT level greater than fivefold exceeding 200 IU/l suggestive of clinical hepatitis that required dose reduction or delayed chemotherapy. Thus, preemptive use of alpha-interferon or lamivudine in HBsAg-positive lymphoma patients undergoing chemotherapy may be a promising approach to prevent HBV reactivation that carries a risk of delayed treatment or even fatal outcome.
authors.affiliation: Department of Internal Medicine, National Cheng-Kung University Hospital Tainan, 138 Sheng Li Road, 70428, Tainan, Taiwan ROC.
authors.forename: Shiang Jiin
authors.initials: SJ
authors.lastname: Leaw
authors.forename: Chia Jui
authors.initials: CJ
authors.lastname: Yen
authors.forename: Wen Tsung
authors.initials: WT
authors.lastname: Huang
authors.forename: Tsai Yun
authors.initials: TY
authors.lastname: Chen
authors.forename: Wu Chou
authors.initials: WC
authors.lastname: Su
authors.forename: Chao Jung
authors.initials: CJ
authors.lastname: Tsao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D015251:Epirubicin / Q000627:therapeutic use*; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000276:immunology / Q000502:physiology*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D019259:Lamivudine / Q000627:therapeutic use*; D008223:Lymphoma / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use*; D011315:Preventive Medicine / Q000379:methods; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention; D014750:Vincristine / Q000627:therapeutic use*; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D006514:Hepatitis B Surface Antigens; D016898:Interferon-alpha; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D015251:Epirubicin; D014750:Vincristine; D003520:Cyclophosphamide; D011241:Prednisone