Emanuela Zappulo1,2,3, Laura Ambra Nicolini1,2, Carmen Di Grazia4, Alida Dominietto4, Teresa Lamparelli4, Francesca Gualandi4, Patrizia Caligiuri5, Bianca Bruzzone6, Emanuele Angelucci4, Claudio Viscoli1,2, Malgorzata Mikulska7,8. 1. Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy. 2. Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Largo R. Benzi 10, 16132, Genoa, Italy. 3. Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy. 4. Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy. 5. Department of Health Sciences, University of Genoa, Genoa, Italy. 6. Hygiene Unit, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy. 7. Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy. m.mikulska@unige.it. 8. Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Largo R. Benzi 10, 16132, Genoa, Italy. m.mikulska@unige.it.
Abstract
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
PURPOSE: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. METHODS: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. RESULTS: 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. CONCLUSIONS: 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.
Authors: K Rajender Reddy; Kimberly L Beavers; Sarah P Hammond; Joseph K Lim; Yngve T Falck-Ytter Journal: Gastroenterology Date: 2014-10-31 Impact factor: 22.682
Authors: C Cerva; L Colagrossi; G Maffongelli; R Salpini; D Di Carlo; V Malagnino; A Battisti; A Ricciardi; M Pollicita; A Bianchi; A Picardi; L Cudillo; R Cerretti; G De Angelis; M Cantonetti; M Andreoni; C F Perno; W Arcese; V Svicher; L Sarmati Journal: Clin Microbiol Infect Date: 2016-07-27 Impact factor: 8.067
Authors: Sarah P Hammond; Anne Marie Borchelt; Chinweike Ukomadu; Vincent T Ho; Lindsey R Baden; Francisco M Marty Journal: Biol Blood Marrow Transplant Date: 2009-06-26 Impact factor: 5.742