title: Fatal fulminant hepatitis B after withdrawal of prophylactic lamivudine in hematopoietic stem cell transplantation patients.
abstract: Hepatitis B virus (HBV) reactivation can give rise to acute hepatitis and even fatal fulminant hepatitis in patients receiving immunosuppressive or cytostatic treatment. Recently, the prophylactic use of lamivudine for HBV reactivation in HBV surface antigen-positive chronic-disease patients undergoing hematopoietic stem cell transplantation (HSCT) has been reported. However, the appropriate duration for this prophylactic therapy is unclear. Here, we report 2 cases of fatal fulminant hepatitis B reactivation in HSCT patients after lamivudine withdrawal. One patient with non-Hodgkin's lymphoma completed 6 courses of CHOP chemotherapy (cyclophosphamide, doxorubicin, vincristine [Oncovin], and prednisone) and autologous peripheral blood SCT (PBSCT). Lamivudine was discontinued 3 months after transplantation. The second patient had acute myeloid leukemia. He received induction chemotherapy and postremission allogeneic PBSCT as late intensified consolidation therapy. Lamivudine treatment was discontinued 10 months after transplantation. In both patients, HBV reactivation 2 to 3 months following lamivudine cessation led to fatal fulminant hepatitis. We suggest that the duration of prophylactic use of lamivudine in chronic HBV carriers receiving HSCT be prolonged until the patient's immune system has been reconstituted.
authors.affiliation: Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei 112, Taiwan.
authors.forename: Peng-Chan
authors.initials: PC
authors.lastname: Lin
authors.forename: Say-Bee
authors.initials: SB
authors.lastname: Poh
authors.forename: Ming-Yang
authors.initials: MY
authors.lastname: Lee
authors.forename: Liang-Tsai
authors.initials: LT
authors.lastname: Hsiao
authors.forename: Po-Min
authors.initials: PM
authors.lastname: Chen
authors.forename: Tzeon-Jye
authors.initials: TJ
authors.lastname: Chiou
mesh_terms: D000208:Acute Disease; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D017809:Fatal Outcome; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006509:Hepatitis B / Q000209:etiology*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D007951:Leukemia, Myeloid / Q000188:drug therapy; D017114:Liver Failure, Acute / Q000209:etiology*; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine