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Lamivudine treatment for acute hepatitis B virus infection during allogeneic peripheral blood stem cell transplantation

Bone Marrow Transplantation volume 31, pages 515–516 (2003)Cite this article

Hepatitis B virus (HBV) infection is a major challenge in patients undergoing hematopoietic stem cell transplantation. In particular, hepatitis B surface antigen (HBsAg) carriers and patients with a latent infection are at high risk for viral reactivation after transplantation.1,2 Acute infection may also be acquired prior to the transplantation procedure from transfusion of infected blood products. After myeloablative and during immunosuppressive therapy most transplanted patients with HBV infection have only mild elevations in transaminases, due to the suppression of host cellular immune responses which cause most of the hepatocellular damage. However, during this period the viral load in the liver progressively increases, which can lead to severe hepatitis at the time of immune reconstitution. Fulminant hepatic failure with a fatal outcome occurs in approximately 12% of HBV-infected transplant recipients.1

To our knowledge, this is the first report in which lamivudine was used to treat acute HBV infection in a patient undergoing allogeneic peripheral blood stem cell transplantation. Our main concern was that unopposed viral replication during the period of immunosuppression would lead to massive infection of the liver and fulminant hepatic necrosis at the time of cessation of immuno-suppressive therapy and immune reconstitution. For this reason, the patient was closely monitored when CsA was tapered and discontinued. However, no serious liver dysfunction occurred, and the transaminase levels remained only slightly elevated. Moreover, HBsAg seroconversion was documented shortly afterward, even though the patient was receiving prednisone for chronic GVHD during this period. Considering the lack of serious side effects and the apparent efficacy, lamivudine appears to be a promising drug to treat or prevent active HBV infection in patients undergoing hematopoietic stem cell transplantation.

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Authors and Affiliations

  1. Department of Hematology, Faculty of Medicine, Vodnjanska 17, Skopje, 1000, Macedonia

    D G Efremov, B Georgievski, L Cevreska, A Pivkova & I Panovska

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  1. D G Efremov
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  2. B Georgievski
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  3. L Cevreska
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  4. A Pivkova
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  5. I Panovska
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Efremov, D., Georgievski, B., Cevreska, L. et al. Lamivudine treatment for acute hepatitis B virus infection during allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 31, 515–516 (2003). https://doi.org/10.1038/sj.bmt.1703909

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