Lamivudine prophylaxis prevents hepatitis B virus reactivation in anti-HBc positive patients under rituximab for non-Hodgkin lymphoma |
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Authors: | Alessandro Loglio Mauro Viganò Glenda Grossi Sara Labanca Maria Goldaniga Alessandra Pompa Lucia Farina Mariagrazia Rumi Paolo Corradini Floriana Facchetti Giovanna Lunghi Luca Baldini Pietro Lampertico |
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Institution: | 1. CRC “A. M. and A. Migliavacca” Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy;2. Division of Hepatology, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy;3. Department of Oncohematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy;4. Department of Hematology and Pediatric Onco-Hematology, IRCCS Istituto Nazionale dei Tumori, Università degli Studi di Milano, Milan, Italy;5. Virology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy |
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Abstract: | BackgoundA significant proportion of hepatitis B surface antigen (HBsAg) negative/anti-hepatitis B core antigen (anti-HBc) positive patients with non-Hodgkin lymphoma (NHL) undergoing rituximab-based chemotherapy (R-CT) may suffer hepatitis B virus (HBV) reactivation.AimsWe wanted to assess efficacy and safety of lamivudine (LMV) prophylaxis to prevent this complication.MethodsEighty-five consecutive HBsAg negative/anti-HBc positive NHL patients (71 years, 100% serum HBV DNA undetectable, 74% anti-HBs positive) received LMV coadministered with R-CT and for 18 months after the end of R-CT. Serum ALT, HBsAg, anti-HBs and HBV DNA were assessed every 4 months during and after end of LMV.ResultsDuring 39 (2–108) months of study period, including 21 months of LMV and 27 additional months after LMV discontinuation, one patient (2%) had HBV reactivation, 31 months after stopping LMV and during administration of new immunosuppressive regimens, without LMV prophylaxis, owing to incomplete oncological response. A 50% decline of anti-HBs titers occurred in 22/63 (35%) patients, including 12 who became anti-HBs seronegative. Five (6%) patients had ALT increase during R-CT but none required R-CT discontinuation. Seventeen (20%) patients died, all for tumour progression.ConclusionLMV prophylaxis is safe and effective in preventing HBV reactivation in HBsAg negative/anti-HBc positive NHL patients receiving R-CT. |
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Keywords: | Anti-CD20 Chemotherapy HBV Nucleoside analog |
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