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Infection

, Volume 47, Issue 1, pp 59–65 | Cite as

Efficacy of lamivudine prophylaxis in preventing hepatitis B virus reactivation in patients with resolved infection undergoing allogeneic SCT and receiving rituximab

  • Emanuela Zappulo
  • Laura Ambra Nicolini
  • Carmen Di Grazia
  • Alida Dominietto
  • Teresa Lamparelli
  • Francesca Gualandi
  • Patrizia Caligiuri
  • Bianca Bruzzone
  • Emanuele Angelucci
  • Claudio Viscoli
  • Malgorzata MikulskaEmail author
Original Paper

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.

Keywords

LAM HBV Anti-CD20 Hematological HBcAb Transplant 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Emanuela Zappulo
    • 1
    • 2
    • 3
  • Laura Ambra Nicolini
    • 1
    • 2
  • Carmen Di Grazia
    • 4
  • Alida Dominietto
    • 4
  • Teresa Lamparelli
    • 4
  • Francesca Gualandi
    • 4
  • Patrizia Caligiuri
    • 5
  • Bianca Bruzzone
    • 6
  • Emanuele Angelucci
    • 4
  • Claudio Viscoli
    • 1
    • 2
  • Malgorzata Mikulska
    • 1
    • 2
    Email author
  1. 1.Division of Infectious Diseases, Department of Health SciencesUniversity of GenoaGenoaItaly
  2. 2.Ospedale Policlinico San Martino-IRCCS per l’OncologiaGenoaItaly
  3. 3.Section of Infectious Diseases, Department of Clinical Medicine and SurgeryUniversity of Naples “Federico II”NaplesItaly
  4. 4.Division of Hematology and Bone Marrow TransplantationOspedale Policlinico San Martino-IRCCS per l’OncologiaGenoaItaly
  5. 5.Department of Health SciencesUniversity of GenoaGenoaItaly
  6. 6.Hygiene UnitOspedale Policlinico San Martino-IRCCS per l’OncologiaGenoaItaly

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