A revisit of prophylactic lamivudine for chemotherapy-associated hepatitis B reactivation in non-Hod

March 4, 2008

A revisit of prophylactic lamivudine for chemotherapy-associated hepatitis B

reactivation in non-Hodgkin's lymphoma: A randomized trial.

Hsu C, Hsiung CA, Su IJ, Hwang WS, Wang MC, Lin SF, Lin TH, Hsiao HH, Young JH,

Chang MC, Liao YM, Li CC, Wu HB, Tien HF, Chao TY, Liu TW, Cheng AL, Chen PJ.

Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.

Lamivudine is effective to control hepatitis B virus (HBV) reactivation in

HBV-carrying cancer patients who undergo chemotherapy, but the optimal treatment

protocol remains undetermined. In this study, HBV carriers with newly diagnosed

non-Hodgkin's lymphoma (NHL) who underwent chemotherapy were randomized to

either prophylactic (P) or therapeutic (T) lamivudine treatment groups. Group P

patients started lamivudine from day 1 of the first course of chemotherapy and

continued treatment until 2 months after completion of chemotherapy. Group T

patients received chemotherapy alone and started lamivudine treatment only if

serum alanine aminotransferase (ALT) levels elevated to greater than 1.5-fold of

the upper normal limit (ULN). The primary endpoint was incidence of HBV

reactivation during the 12 months after starting chemotherapy. During

chemotherapy, fewer group P patients had HBV reactivation (11.5% versus 56%, P =

0.001), HBV-related hepatitis (7.7% versus 48%, P = 0.001), or severe hepatitis

(ALT more than 10-fold ULN) (0 versus 36%, P < 0.001). No hepatitis-related

deaths occurred during protocol treatment. Prophylactic lamivudine use was the

only independent predictor of HBV reactivation. After completion of

chemotherapy, the incidence of HBV reactivation did not differ between the 2

groups. Two patients, both in group P, died of HBV reactivation-related

hepatitis, 173 and 182 days, respectively, after completion of protocol

treatment. When compared with an equivalent group of lamivudine-naïve lymphoma

patients who underwent chemotherapy, therapeutic use of lamivudine neither

reduced the severity of HBV-related hepatitis nor changed the patterns of HBV

reactivation. Conclusion: Prophylactic lamivudine use, but not therapeutic use,

reduces the incidence and severity of chemotherapy-related HBV reactivation in

NHL patients.

(HEPATOLOGY 2008;47:844-853.).

PMID: 18302293 [PubMed - as supplied by publisher]

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