title: Lamivudine treatment in a patient with hepatitis B virus reactivation after allogenic peripheral bone marrow transplantation.
abstract: We report the case of a 52-year-old woman with hepatitis B virus (HBV) reactivation during treatment for chronic graft vs. host disease (GVHD) after peripheral bone marrow transplantation (PBSCT) to treat chronic myelocytic leukemia. She was given cyclosporine and prednisolone orally to treat chronic GVHD after PBSCT. Liver dysfunction first developed 25 months after transplantation with the appearance of hepatitis B s antigen (HBsAg), hepatitis B e antigen (HBeAg), and elevation of HBV-DNA up to 4.5 log copies/ml. Retrospective examination of her serum before PBSCT proved negative for HBsAg and HBeAg, and positive for anti-HBsAg, anti-HBeAg, anti-hepatitis B core antigen, and HBV-DNA (2.7 log copies/ml), showing that she was in a state of occult HBV infection. Nucleotide sequences of the HBV genome obtained from her serum showed no core promoter mutations at nt 1762 and 1764 and no pre-core mutation at nt 1896. Polymerase chain reaction-restriction fragment length polymorphism showed that she was infected with HBV genotype B. The administration of lamivudine, a nucleoside analog, improved her liver function and reduced HBV-DNA replication. We conclude that antiviral agents, such as lamivudine, are effective for treating hepatitis B reactivation during immunosuppressive treatment, such as for GVHD. The administration of a nucleoside analog before transplantation should also be considered in the light of HBV genotypes and mutations, even if HBsAg was negative and the viral load was low before transplantation.
authors: Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan. Taimamura@aol.com
authors: Takaaki
authors: T
authors: Imamura
authors: Osamu
authors: O
authors: Yokosuka
authors: Tetsuhiro
authors: T
authors: Chiba
authors: Tatso
authors: T
authors: Kanda
authors: Hiroshige
authors: H
authors: Kojima
authors: Kenichi
authors: K
authors: Fukai
authors: Fumio
authors: F
authors: Imazeki
authors: Miki
authors: M
authors: Nishimura
authors: Yasushi
authors: Y
authors: Saito
authors: Hiromitsu
authors: H
authors: Saisho
mesh_terms: D000956:Antigens, Viral / Q000737:chemistry; D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D004261:DNA Replication; D005260:Female; D006086:Graft vs Host Disease; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000378:metabolism*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D008099:Liver / Q000378:metabolism; D008875:Middle Aged; D009154:Mutation
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D019259:Lamivudine