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- Title
Management of Hepatitis B Virus Reactivation in Patients with Hematological Malignancies Treated with Chemotherapy.
- Authors
Francisci, D.; Falcinelli, F.; Schiaroli, E.; Capponi, M.; Belfiori, B.; Flenghi, L.; Baldelli, F.
- Abstract
Hepatitis B virus (HBV) reactivation is a majorcause of morbidity and mortality in patients with hematologicalmalignancies who receive cytotoxic chemotherapy. Wehave therefore carried out a prospective observational studyout to assess the incidence, prevalence, and clinical course ina cohort of these patients. HBV and HCV markers and liver function indiceswere monitored prospectively in 318 consecutive patients(171 males, 147 females; mean age 57 years) with hematologicalmalignancies, who had been referred to the HematologyDivision, Perugia University, between October 2005and March 2007 and followed up for at least 6 months. At diagnosis, 32 patients (10%) had received HBVvaccination; 30 were responders. At least one HBV marker waspositive 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+ patientsreceived nucleoside/nucleotide analogs (adefovir [six patients],lamivudine [four], and combined adefovir/lamivudine[two non-responders to lamivudine]). After 6 months oftherapy, HBV-DNA was negative and transaminases were normalin nine of these 12 patients (adefovir [six], lamivudina[two], adefovir + lamivudina [one]). Seroreversion wasachieved 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 whowere anti-HBc- and anti-HBs positive. Essential to the management of patients withhematological malignancies undergoing chemotherapy aresurveillance and prophylaxis of HBV infection together withprompt administration of nucleoside/nucleotide analogs incases of reactivation and/or seroreversion.
- Subjects
HEPATITIS B virus; DRUG therapy; HEMATOLOGY; VACCINATION; ANTIGENS
- Publication
Infection, 2010, Vol 38, Issue 1, p58
- ISSN
0300-8126
- Publication type
Article
- DOI
10.1007/s15010-009-9019-1