Administration of immunosuppressive treatment in hepatitis B virus carriers with
malignancies is associated with the risk of
hepatitis B reactivation. This complication is more frequent in patients with
hematologic malignancies because administration of
corticosteroids, the mainstay of treatment of these patients, is an independent risk factor for
hepatitis B reactivation. When
lamivudine is given prior to
chemotherapy, it prevents the viral replication during the immunosuppression period; therefore, it might reduce the risk of
hepatitis B exacerbation. We performed a prospective study to assess the efficacy of prophylactic administration of
lamivudine in this setting. Ten hepatitis B virus carriers with
hematologic malignancies were included in this study; seven were
HBsAg positive, and three had isolated antiHBc and detectable HBV-
DNA levels. Nine patients were given
corticosteroids after the administration of
lamivudine.
Lamivudine was given per os at a dose of 100 mg once daily. In four patients that had not been previously treated with
chemotherapy,
lamivudine was started 19 days (median) (range, 0-35 days) prior to the onset of
chemotherapy. The administration of
lamivudine has not stopped since in any of our patients. After a median follow-up of 15 months (range 6-38 months), no
hepatitis B reactivation was observed. HBV-
DNA levels were decreased in all 6 patients who had detectable HBV-
DNA at baseline.
Lamivudine was well tolerated.
Chemotherapy regimens were administered as planned, and their effectiveness was not compromised by
lamivudine. In conclusion, prophylactic administration of
lamivudine should be considered as a means of reducing the frequency of
hepatitis B reactivation in hepatitis B virus carriers with
hematologic malignancies who are being treated with
chemotherapy.