Adriana Boemio, Carmine Minichini, Salvatore Guastafierro, Nicolina Capoluongo, Lucia Mastrullo, Mariantonietta Pisaturo, Chiara D'Amore, Luigi Elio Adinolfi, Nicola Coppola, Mariarosaria Esposito, Evangelista Sagnelli, Aldo Marrone, Luca Rinaldi, Lorenzo Onorato, Margherita Macera, Isabella Siniscalchi
This study evaluated the long-term efficacy and safety of an 18-month lamivudine prophylaxis in 68 HBsAg-negative/anti-HBc-positive patients with onco-hematological disease.
All 68 consecutive HBsAg-negative/anti-HBc-positive patients with an onco-hematological disease and naïve for chemotherapy observed from April 2008 to December 2012 at two Hematology Units in Naples were treated with lamivudine for 18 months after stopping chemotherapy and monitored for HBsAg at months 1 and 3 during chemotherapy and then every three months after its discontinuation. During follow-up, 13 (19.1%) of the 68 patients died of complications related to their onco-hematological disease and three (4%) showed a virological HBV reactivation (retroconversion to HBsAg positivity) 1-7 months after the discontinuation of lamivudine-prophylaxis (2 treated for chronic lymphocytic leukemia and one for Waldenstrom's disease); of these, two showed a biochemical reactivation. Comparing the demographic and clinical characteristics of the 3 patients with a virological HBV reactivation to the 65 without, the former were older [median age and range: 67 years (75-78) vs. 61 (24-88); p=0.05] and were less frequently treated for B-cell non-Hodgkin lymphoma (B-NHL) (0 vs. 70.7%, p=0.03). In conclusion, a 18-months of lamivudine prophylaxis was effective in preventing HBV reactivation in HBsAg-negative/anti-HBc-positive patients treated for B-NHL. However, in patients with chronic and severe immunodepression, such as those with chronic lymphocytic leukemia and Waldenstrom's disease, prophylaxis should be continued for an indefinite period.
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