Hepatitis B reactivation after withdrawal of pre-emptive lamivudine in patients with haematological malignancy on completion of cytotoxic chemotherapy

Gut. 2005 Nov;54(11):1597-603. doi: 10.1136/gut.2005.070763. Epub 2005 Jul 6.

Abstract

Background: The hepatic outcome of hepatitis B surface antigen (HBsAg) positive patients undergoing chemotherapy after withdrawal of pre-emptive lamivudine is unknown.

Aims: To examine the occurrence of hepatitis B virus (HBV) reactivation after withdrawal of pre-emptive lamivudine.

Methods: Pre-emptive lamivudine was started one week before initiation of chemotherapy in 46 consecutive HBsAg positive patients and continued for the entire duration of chemotherapy. Pre-emptive lamivudine was stopped at a median 3.1 (range 3.0-3.4) months after completion of chemotherapy. Patients were longitudinally followed up after withdrawal of pre-emptive lamivudine.

Results: Median time of follow up after withdrawal of lamivudine was 25.7 (range 5.7-75.7) months. Eleven of the 46 patients (23.9%) developed HBV reactivation after withdrawal of pre-emptive lamivudine. Eight of the 16 patients with high pre-chemotherapy HBV DNA (> or =10(4) copies/ml) compared with three of the 30 patients with low pre-chemotherapy HBV DNA (<10(4) copies/ml) developed HBV reactivation (50.0% v 10.0%, respectively; p<0.001). Hepatitis B e antigen positive patients were also more likely to develop HBV reactivation (5/11 (45.5%) v 6/35 (17.1%), respectively; p = 0.041). A high pre-chemotherapy HBV DNA (> or =10(4) copies/ml) was the most important risk factor for HBV reactivation after withdrawal of pre-emptive lamivudine on Cox proportional hazards analysis (relative risk 16.13, (95% confidence interval 2.99-87.01; p = 0.001).

Conclusions: HBV reactivation is more likely to occur in patients with high pre-chemotherapy HBV DNA after withdrawal of pre-emptive lamivudine. A more prolonged course of antiviral therapy may be necessary in these patients after completion of chemotherapy in order to reduce post-chemotherapy HBV reactivation.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents / adverse effects
  • Antiviral Agents / therapeutic use
  • DNA, Viral / analysis
  • Female
  • Follow-Up Studies
  • Hematologic Neoplasms / complications
  • Hematologic Neoplasms / drug therapy*
  • Hepatitis B / immunology
  • Hepatitis B / prevention & control*
  • Hepatitis B / virology
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B virus / isolation & purification
  • Hepatitis B virus / physiology*
  • Humans
  • Immunocompromised Host
  • Lamivudine / therapeutic use*
  • Male
  • Middle Aged
  • Virus Activation / drug effects*

Substances

  • Antineoplastic Agents
  • Antiviral Agents
  • DNA, Viral
  • Hepatitis B Surface Antigens
  • Lamivudine