title: A revisit of prophylactic lamivudine for chemotherapy-associated hepatitis B reactivation in non-Hodgkin's lymphoma: a randomized trial.
abstract: Lamivudine is effective to control hepatitis B virus (HBV) reactivation in HBV-carrying cancer patients who undergo chemotherapy, but the optimal treatment protocol remains undetermined. In this study, HBV carriers with newly diagnosed non-Hodgkin's lymphoma (NHL) who underwent chemotherapy were randomized to either prophylactic (P) or therapeutic (T) lamivudine treatment groups. Group P patients started lamivudine from day 1 of the first course of chemotherapy and continued treatment until 2 months after completion of chemotherapy. Group T patients received chemotherapy alone and started lamivudine treatment only if serum alanine aminotransferase (ALT) levels elevated to greater than 1.5-fold of the upper normal limit (ULN). The primary endpoint was incidence of HBV reactivation during the 12 months after starting chemotherapy. During chemotherapy, fewer group P patients had HBV reactivation (11.5% versus 56%, P = 0.001), HBV-related hepatitis (7.7% versus 48%, P = 0.001), or severe hepatitis (ALT more than 10-fold ULN) (0 versus 36%, P < 0.001). No hepatitis-related deaths occurred during protocol treatment. Prophylactic lamivudine use was the only independent predictor of HBV reactivation. After completion of chemotherapy, the incidence of HBV reactivation did not differ between the 2 groups. Two patients, both in group P, died of HBV reactivation-related hepatitis, 173 and 182 days, respectively, after completion of protocol treatment. When compared with an equivalent group of lamivudine-naïve lymphoma patients who underwent chemotherapy, therapeutic use of lamivudine neither reduced the severity of HBV-related hepatitis nor changed the patterns of HBV reactivation.
  
  
  CONCLUSIONS
  Prophylactic lamivudine use, but not therapeutic use, reduces the incidence and severity of chemotherapy-related HBV reactivation in NHL patients.
authors.affiliation: Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chiun
authors.initials: C
authors.lastname: Hsu
authors.forename: Chao A
authors.initials: CA
authors.lastname: Hsiung
authors.forename: Ih-Jen
authors.initials: IJ
authors.lastname: Su
authors.forename: Wei-Shou
authors.initials: WS
authors.lastname: Hwang
authors.forename: Ming-Chung
authors.initials: MC
authors.lastname: Wang
authors.forename: Sheng-Fung
authors.initials: SF
authors.lastname: Lin
authors.forename: Tseng-Hsi
authors.initials: TH
authors.lastname: Lin
authors.forename: Hui-Hua
authors.initials: HH
authors.lastname: Hsiao
authors.forename: Ji-Hsiung
authors.initials: JH
authors.lastname: Young
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Chang
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Liao
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Li
authors.forename: Hung-Bo
authors.initials: HB
authors.lastname: Wu
authors.forename: Hwei-Fang
authors.initials: HF
authors.lastname: Tien
authors.forename: Tsu-Yi
authors.initials: TY
authors.lastname: Chao
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine