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

Authors

  • S.E. Moses,

    1. London South Specialist Virology Centre and Health Protection Agency London, London
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    • Specialist Registrar in Virology.

  • Z.Y. Lim,

    1. Department of Haematological Medicine, Kings College London and Kings College Hospital, Denmark Hill, London, United Kingdom
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    • Research Fellow in Hematology.

  • M. Sudhanva,

    1. London South Specialist Virology Centre and Health Protection Agency London, London
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    • Consultant Virologist.

  • S. Devereux,

    1. Department of Haematological Medicine, Kings College London and Kings College Hospital, Denmark Hill, London, United Kingdom
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    • Consultant Hematologist.

  • A.Y.L. Ho,

    1. Department of Haematological Medicine, Kings College London and Kings College Hospital, Denmark Hill, London, United Kingdom
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    • Consultant Hematologist.

  • A. Pagliuca,

    1. Department of Haematological Medicine, Kings College London and Kings College Hospital, Denmark Hill, London, United Kingdom
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    • Consultant Hematologist.

  • M. Zuckerman,

    Corresponding author
    1. London South Specialist Virology Centre and Health Protection Agency London, London
    • London South Specialist Virology Centre, Health Protection Agency London, King's College Hospital NHS Trust, The Rayne Institute, 123 Coldharbour Lane, London SE5 9NU, United Kingdom.
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    • Consultant Virologist.

  • G.J. Mufti

    1. Department of Haematological Medicine, Kings College London and Kings College Hospital, Denmark Hill, London, United Kingdom
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    • Professor of Hematology.


Abstract

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.

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