Hepatitis B virus reactivation and efficacy of prophylaxis with lamivudine in patients undergoing allogeneic stem cell transplantation.
Patients previously infected with hepatitis B virus (HBV) undergoing an allograft and recipients from HBV carrier donors are at risk of posttransplant viral reactivation. The role of prophylaxis with lamivudine remains unclear. One hundred seventeen patients, with a median age of 52 years (20-67 years), with various hematologic malignancies transplanted between 1999 and 2007 entered the study. Eighty-seven recipients negative for HBV surface antigen (HBsAg), antihepatitis B core antigen antibodies (anti-HBc), and HBV-DNA with HBsAg and HBV-DNA negative donors were defined as at low risk of HBV reactivation, whereas all the remaining 30 patients were defined as at high risk. Patients at high risk transplanted in 2005 or after received lamivudine to prevent HBV reactivation as per the Italian guidelines by the Associazione Italiana per lo Studio del Fegato (AISF). Patients at low risk did not experience HBV reactivation/hepatitis. Among the recipients at high risk, 11 of 25 anti-HBc positive, those HBsAg positive (2 of 2) or negative but transplanted from HBsAg positive donors (3 of 3) were treated with lamivudine. None of these developed HBV reactivation/hepatitis after a median follow-up of 40 months (17-55 months). Hepatitis developed in 3 anti-HBc positive untreated patients conditioned with a reduced-intensity regimen. Hepatitis B was not observed in recipients at low risk, transplanted from HBsAg negative/anti-HBc positive or negative donors. Lamivudine was effective in controlling reactivation in: HBsAg positive recipients, in patients transplanted from HBsAg positive donors and in HBsAg negative/antiHBc positive recipients, who showed a significant risk of reactivation if not given prophylaxis (NCT 00876148).
Giaccone
Luisa
L
Division of Hematology, SGB Hospital, University of Torino, Torino, Italy. luisa.giaccone@unito.it
Festuccia
Moreno
M
Marengo
Andrea
A
Resta
Isabel
I
Sorasio
Roberto
R
Pittaluga
Fabrizia
F
Fiore
Francesca
F
Boccadoro
Mario
M
Rizzetto
Mario
M
Bruno
Benedetto
B
Marzano
Alfredo
A
D000328:Adult; D000368:Aged; D001782:Blood Donors; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis; D019337:Hematologic Neoplasms / Q000601:surgery; D006509:Hepatitis B / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control* / Q000821:virology*; D006510:Hepatitis B Antibodies / Q000097:blood / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood / Q000276:immunology; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology / Q000502:physiology; D006801:Humans; D019259:Lamivudine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects*; D055815:Young Adult
D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine