Management of hepatitis B virus reactivation in patients with hematological malignancies treated with chemotherapy.
BACKGROUND
Hepatitis B virus (HBV) reactivation is a major cause of morbidity and mortality in patients with hematological malignancies who receive cytotoxic chemotherapy. We have therefore carried out a prospective observational study out to assess the incidence, prevalence, and clinical course ina cohort of these patients.


METHODS
HBV and HCV markers and liver function indices were monitored prospectively in 318 consecutive patients(171 males, 147 females; mean age 57 years) with hematological malignancies, who had been referred to the Hematology Division, Perugia University, between October 2005 and March 2007 and followed up for at least 6 months.


RESULTS
At diagnosis, 32 patients (10%) had received HBV vaccination; 30 were responders. At least one HBV marker was positive in 70/318 patients (22%): 14 (20%) were HBsAg-positive(HBV surface antigen-positive), 13 (19%) were only anti-HBc positive (antibodies to HB core antigen), and 43(61%)were anti-HBc and anti-HBs positive. Twelve HBsAg+ patients received nucleoside/nucleotide analogs (adefovir [six patients],lamivudine [four], and combined adefovir/lamivudine[two non-responders to lamivudine]). After 6 months of therapy, HBV-DNA was negative and transaminases were normal in nine of these 12 patients (adefovir [six], lamivudina[two], adefovir + lamivudina [one]). Seroreversion was achieved in 3/13 patients (23%) who were only anti-HBc positive;all were on rituximab therapy and received adefovir. Seroreversion was not observed in any of the 43 patients who were anti-HBc- and anti-HBs positive.


CONCLUSIONS
Essential to the management of patients with hematological malignancies undergoing chemotherapy are surveillance and prophylaxis of HBV infection together with prompt administration of nucleoside/nucleotide analogs in cases of reactivation and/or seroreversion.
Francisci
D
D
Dept. of Experimental Medicine and Biochemical Science, University of Perugia, Ospedale "Santa Maria della Misericordia", Italy.
Falcinelli
F
F
Schiaroli
E
E
Capponi
M
M
Belfiori
B
B
Flenghi
L
L
Baldelli
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy*; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000175:diagnosis* / Q000188:drug therapy*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D007558:Italy; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014775:Virus Activation; D055815:Young Adult
D000970:Antineoplastic Agents; D000998:Antiviral Agents