1. Efficacy of lamivudine prophylaxis in preventing hepatitis B virus reactivation in patients with resolved infection undergoing allogeneic SCT and receiving rituximab
- Author
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Patrizia Caligiuri, Malgorzata Mikulska, Emanuele Angelucci, Emanuela Zappulo, Alida Dominietto, Bianca Bruzzone, Claudio Viscoli, Teresa Lamparelli, Carmen Di Grazia, Laura Ambra Nicolini, and Francesca Gualandi
- Subjects
Male ,0301 basic medicine ,HBcAb ,Transplant ,medicine.disease_cause ,Gastroenterology ,Anti-CD20 ,0302 clinical medicine ,immune system diseases ,hemic and lymphatic diseases ,HBV ,Hematological ,030212 general & internal medicine ,education.field_of_study ,Myeloid leukemia ,Lamivudine ,General Medicine ,Middle Aged ,Hepatitis B ,Haploidentical Donor ,Safety profile ,Infectious Diseases ,Italy ,Hematologic Neoplasms ,Female ,Rituximab ,medicine.drug ,Adult ,Microbiology (medical) ,Hepatitis B virus ,medicine.medical_specialty ,030106 microbiology ,Population ,Antiviral Agents ,Young Adult ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,In patient ,education ,Aged ,LAM ,business.industry ,Antibiotic Prophylaxis ,Virus Activation ,business ,Stem Cell Transplantation - Abstract
Hepatitis B virus (HBV) reactivation during immunosuppressive therapy is common in patients with hematological malignancies, even in case of resolved infection. Prophylaxis of HBV reactivation is universally recommended in stem cell transplant (SCT) recipients and patients treated with anti-CD20 agents (i.e., rituximab). Despite its well-established favorable safety profile, lamivudine (LAM) use in prophylaxis has been debated because of the possible emergence of resistant viral strains. The aim of this study was to investigate the efficacy of LAM in preventing HBV reactivation in allogeneic SCT recipients with a resolved HBV infection. Patients who received first allogeneic SCT in years 2009–2016 were evaluated. Sixty-three patients with resolved infection received LAM prophylaxis and were included in the study. Baseline and post-SCT characteristics were recorded, including rituximab exposure, length of LAM prophylaxis, and time from transplant to the last clinical and virological follow-up. Overall, 39 patients (62%) were male, 39 (62%) had acute myeloid leukemia, 38 (60%) received transplant from haploidentical donor, 29 (53%) received myeloablative conditioning, and 15 (24%) received rituximab post-transplant. Median clinical follow-up was 24 months after SCT (range 0.3–97); median virological follow-up 16 months (range 0.3–78), and median length of LAM prophylaxis of 14.5 months (range 0.3–78). No patient experienced HBV reactivation while on LAM prophylaxis. One patient experienced reactivation 8 months after discontinuing prophylaxis. In this high-risk population, LAM prophylaxis was effective in preventing HBV reactivation in patients with resolved infection. It should be considered a reasonable first-line prophylactic agent to be administered in this setting.
- Published
- 2018