Fatal fulminant hepatitis B after withdrawal of prophylactic lamivudine in hematopoietic stem cell transplantation patients.
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.
Lin
Peng-Chan
PC
Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei 112, Taiwan.
Poh
Say-Bee
SB
Lee
Ming-Yang
MY
Hsiao
Liang-Tsai
LT
Chen
Po-Min
PM
Chiou
Tzeon-Jye
TJ
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
D019380:Anti-HIV Agents; D019259:Lamivudine