Prophylaxis of hepatitis B reactivation using lamivudine in a patient receiving rituximab

Citation
T. Hamaki et al., Prophylaxis of hepatitis B reactivation using lamivudine in a patient receiving rituximab, AM J HEMAT, 68(4), 2001, pp. 292-294
Citations number
10
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Hematology,"Cardiovascular & Hematology Research
Journal title
AMERICAN JOURNAL OF HEMATOLOGY
ISSN journal
0361-8609 → ACNP
Volume
68
Issue
4
Year of publication
2001
Pages
292 - 294
Database
ISI
SICI code
0361-8609(200112)68:4<292:POHBRU>2.0.ZU;2-4
Abstract
A 53-year-old man who had a history of fluminant hepatitis caused by precor e mutant hepatitis B virus (HBV) was admitted to our hospital for the treat ment of relapsed non-Hodgkin's lymphoma in July 2000. At admission, serum l evels of aspartate aminotransferase and alanine aminotransferase were norma l, but he tested positive for HBs antigen. The titer was 64-fold by radioim munoassay. We initiated lamivudine at a daily dose of 75 mg to prevent HBV proliferation during chemotherapy. By September 2000, he had received six c ourses of rituximab at 375 mg/m(2) and four courses of fludarabine and mito xantrone. No hepatic damage was observed from the initiation of treatment u ntil March 2001. At present, four months after the completion of chemothera py, he continues lamivudine, and the titer of HBs antigen is low at 4-fold. Rituximab is usually associated with mild toxicity, usually limited to inf usion periods. The drug is not generally associated with increased incidenc e of opportunistic infections. However, some case reports have been recentl y published on severe viral infections following administration of rituxima b. These include fluminant hepatitis caused by HBV, pure red cell aplasia d ue to parvovirus B19 and fatal varicella-zoster infection. While it remains unknown whether rituximab can be safely administered in patients with chro nic HBV infection, this case report suggested that prophylactic administrat ion of lamivudine is beneficial for suppressing reactivation of HBV during chemotherapy including rituximab. Rituximab should be used cautiously for p atients with HBV infection, but prophylactic administration of lamivudine m ay be beneficial for preventing reactivation of HBV. (C) 2001 Wiley-Liss, I nc.