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Management of Hepatitis B Virus Reactivation in Patients with Hematological Malignancies Treated with Chemotherapy

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Abstract

Introduction:

Hepatitis B virus (HBV) reactivation is a majorcause of morbidity and mortality in patients with hematologicalmalignancies who receive cytotoxic chemotherapy. Wehave therefore carried out a prospective observational studyout to assess the incidence, prevalence, and clinical course ina cohort of these patients.

Methods:

HBV and HCV markers and liver function indiceswere monitored prospectively in 318 consecutive patients(171 males, 147 females; mean age 57 years) with hematologicalmalignancies, who had been referred to the HematologyDivision, Perugia University, between October 2005and March 2007 and followed up for at least 6 months.

Results:

At diagnosis, 32 patients (10%) had received HBVvaccination; 30 were responders. At least one HBV marker waspositive in 70/318 patients (22%): 14 (20%) were HBsAg-positive(HBV surface antigen-positive), 13 (19%) were only anti-HBc positive (antibodies to HB core antigen), and 43(61%)were anti-HBc and anti-HBs positive. Twelve HBsAg+ patientsreceived nucleoside/nucleotide analogs (adefovir [six patients],lamivudine [four], and combined adefovir/lamivudine[two non-responders to lamivudine]). After 6 months oftherapy, HBV-DNA was negative and transaminases were normalin nine of these 12 patients (adefovir [six], lamivudina[two], adefovir + lamivudina [one]). Seroreversion wasachieved in 3/13 patients (23%) who were only anti-HBc positive;all were on rituximab therapy and received adefovir.Seroreversion was not observed in any of the 43 patients whowere anti-HBc- and anti-HBs positive.

Conclusions:

Essential to the management of patients withhematological malignancies undergoing chemotherapy aresurveillance and prophylaxis of HBV infection together withprompt administration of nucleoside/nucleotide analogs incases of reactivation and/or seroreversion.

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Correspondence to B. Belfiori.

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Francisci, D., Falcinelli, F., Schiaroli, E. et al. Management of Hepatitis B Virus Reactivation in Patients with Hematological Malignancies Treated with Chemotherapy. Infection 38, 58–61 (2010). https://doi.org/10.1007/s15010-009-9019-1

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  • DOI: https://doi.org/10.1007/s15010-009-9019-1

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