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Treatment of refractory chronic lymphocytic leukemia with Campath-1H in combination with lamivudine in chronic hepatitis B infection

Authors

  • Ulrike Heider,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • 1 Claudia Fleissner,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • 1 Ivana Zavrski,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • 1 Christian Jakob,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • 1 Toralf Dietzel,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • 1 Jan Eucker,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • 1 Johann Ockenga,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • 2 Kurt Possinger,

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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  • and 1 Orhan Sezer 1

    1. 1Department of Haematology and Oncology , and 2Department of Gastroenterology, Hepatology and Endocrinology Charité, Humboldt-University Berlin, Germany
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Dr Orhan Sezer, Department of Haematology and Oncology, Universitätsklinikum Charité, 10098 Berlin, Germany
Tel: +49-30-450 513105
Fax: +49-30-450 527907
e-mail: sezer@charite.de

Abstract:

Campath-1H, a monoclonal antibody against human CD52, is used for the therapy of refractory or relapsed chronic lymphocytic leukemia (CLL). Treatment with campath is associated with an increased incidence of infections and also fatal reactivation of viral infections. Reactivation of hepatitis B virus (HBV) in HBsAg-positive patients is a well-documented complication of cytotoxic or immunosuppressive therapy and has also been observed after treatment with rituximab. To date, there are no reports on campath treatment in HBsAg carriers. Here, we present the case of a patient with heavily pretreated CLL who was HBsAg-positive with a high virus load (>2 billion copies/mL). He required treatment because of progressive CLL with massive bone marrow infiltration, severe anemia and thrombocytopenia. Campath was initiated and lamivudine, an inhibitor of reverse transcriptase, was simultaneously given to prevent HBV proliferation. During the treatment, no deterioration of liver parameters was observed, and the virus load decreased. After therapy with campath, hemoglobin and platelet counts increased markedly. This report shows that lamivudine is highly effective in inhibiting HBV proliferation and can be used to prevent HBV flare-up during campath treatment in patients tested positive for HBs antigen.

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