Lamivudine prophylaxis and treatment of hepatitis B Virus-exposed recipients receiving reduced intensity conditioning hematopoietic stem cell transplants with alemtuzumab

• Published in: Journal of medical virology Vol. 78; no. 12; pp. 1560 - 1563
• Main Authors: Moses, S.E., Lim, Z.Y., Sudhanva, M., Devereux, S., Ho, A.Y.L., Pagliuca, A., Zuckerman, M., Mufti, G.J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2006; Wiley-Liss
• Subjects: Adolescent; Adult; Aged; Alemtuzumab; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - administration & dosage; Antineoplastic Agents - administration & dosage; Biological and medical sciences; bone marrow transplantation; Chemoprevention; Female; Fundamental and applied biological sciences. Psychology; HBV reactivation; Hematopoietic Stem Cell Transplantation - adverse effects; Hepatitis B - drug therapy; Hepatitis B - prevention & control; Hepatitis B - virology; Hepatitis B virus; Hepatitis B virus - drug effects; Hepatitis B virus - physiology; Human viral diseases; Humans; Infectious diseases; lamivudine; Lamivudine - therapeutic use; Male; Medical sciences; Microbiology; Middle Aged; Miscellaneous; Reverse Transcriptase Inhibitors - therapeutic use; Treatment Outcome; Viral diseases; Virology; Virus Activation; Stem cell; Orthohepadnavirus; Hematopoietic cell; Lamivudine; Recipient; Transplantation; Alemtuzumab; bone marrow transplantation; Virus; Prevention; Treatment; Hepadnaviridae; HBV reactivation; Bone marrow; Antiviral; Hepatitis B virus
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.20705

Individuals with past exposure to hepatitis B virus (HBV) may reactivate HBV following bone marrow transplantation. Alemtuzumab (CAMPATH)‐based reduced intensity conditioning bone marrow transplantation has been associated with a high incidence of viral infections. Lamivudine prophylaxis for HBV should be instituted in this setting. The management of 240 CAMPATH‐based reduced intensity conditioning bone marrow transplantation, carried out over an 8‐year period at Kings College Hospital, was reviewed. Hepatitis B core total antibody (anti‐HBc) testing identified recipients and donors with previous HBV exposure. Fifteen donor–recipient pairs were identified as being at risk of HBV reactivation. Eight recipients of anti‐HBc negative donors were HBsAg negative, anti‐HBc positive pre‐transplantation. Five anti‐HBc negative recipients received transplants from HBsAg negative, anti‐HBc positive donors. Two HBV carrier recipients had one anti‐HBc negative and one positive donor, respectively. Pre‐transplant lamivudine prophylaxis was given to 8/10 (80%) anti‐HBc positive recipients. Although HBsAg and HBV DNA were detected 4 months after bone marrow transplantation in one patient who did not receive prophylaxis, a good antiviral response was documented on starting lamivudine. The two HBV carrier recipients had stopped lamivudine at 8 and 31 months post‐bone marrow transplantation, respectively, and died of liver failure with a sharp rise in HBV DNA levels. The five anti‐HBc negative recipients with anti‐HBc positive donors remained HBsAg and HBV DNA negative. Although lamivudine prophylaxis prevented HBV reactivation, it is unclear at what stage post‐transplantation prophylaxis can be discontinued. Close monitoring of liver function tests (LFTs), HBsAg, and HBV DNA must be undertaken even after stopping antiviral prophylaxis. J. Med. Virol. 78:1560–1563, 2006. © 2006 Wiley‐Liss, Inc.