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

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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.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Health Sciences, University of Genoa, Genoa, Italy

    Emanuela Zappulo, Laura Ambra Nicolini, Claudio Viscoli & Malgorzata Mikulska

  2. Ospedale Policlinico San Martino-IRCCS per l’Oncologia, Largo R. Benzi 10, 16132, Genoa, Italy

    Emanuela Zappulo, Laura Ambra Nicolini, Claudio Viscoli & Malgorzata Mikulska

  3. Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy

    Emanuela Zappulo

  4. Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l’Oncologia, Genoa, Italy

    Carmen Di Grazia, Alida Dominietto, Teresa Lamparelli, Francesca Gualandi & Emanuele Angelucci

  5. Department of Health Sciences, University of Genoa, Genoa, Italy

    Patrizia Caligiuri

  6. Hygiene Unit, Ospedale Policlinico San Martino-IRCCS per l’Oncologia, Genoa, Italy

    Bianca Bruzzone

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  1. Emanuela Zappulo
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Correspondence to Malgorzata Mikulska.

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Zappulo, E., Nicolini, L.A., Di Grazia, C. et al. Efficacy of lamivudine prophylaxis in preventing hepatitis B virus reactivation in patients with resolved infection undergoing allogeneic SCT and receiving rituximab. Infection 47, 59–65 (2019). https://doi.org/10.1007/s15010-018-1214-5

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  • DOI: https://doi.org/10.1007/s15010-018-1214-5

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