Delayed hepatitis B virus reactivation after cessation of preemptive lamivudine in lymphoma patients treated with rituximab plus CHOP

[Guest guest]

Ann Hematol. 2004 Aug 25 [Epub ahead of print]

Delayed hepatitis B virus reactivation after cessation of preemptive

lamivudine in lymphoma patients treated with rituximab plus CHOP.

Dai MS, Chao TY, Kao WY, Shyu RY, Liu TM.

Division of Hematology/Oncology, Department of Medicine, Tri-Service General

Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Section

2, Neihu 114, Taipei, Taiwan ROC.

Preemptive lamivudine in lymphoma patients undergoing intensive chemotherapy

can effectively prevent chemotherapy-related HBV reactivation. Nevertheless,

the safety profile after withdrawal of lamivudine and the impact of

rituximab-containing chemotherapy on HBV reactivation has not been defined.

To illustrate the necessity of prolonged surveillance after cessation of

preemptive lamivudine in lymphoma patients treated with rituximab and

chemotherapy, four patients with B-cell NHL carrying HBV received rituximab

plus CHOP. Preemptive lamivudine therapy was administered 1 week before

chemotherapy until 4 weeks after completion of chemotherapy. Serial serum

alanine aminotransferase (ALT), total bilirubin, and HBV-DNA levels were

prospectively monitored in three patients. The fourth patient was closely

monitored for ALT. The HBV DNA was checked after development of clinical

overt hepatitis. The peripheral blood CD20(+) B-lymphocyte counts were

analyzed periodically in two patients. All of the three patients studied

prospectively had virological relapses with surgence of HBV DNA 6-8 months

after completion of rituximab-plus-CHOP (R+CHOP) therapy. Two of the three

patients had biochemical relapses and one of them developed severe

hepatitis. Sequencing for HBV polymerase gene in these patients failed to

show evident emergence of lamivudine-resistant mutations. The fourth patient

developed a hepatitis flare-up 6 months after completion of chemotherapy.

The CD20(+) lymphocytes were totally depleted when HBV DNA started to

increase. Delayed HBV reactivation can occur in lymphoma patients receiving

R+CHOP after withdrawal of preemptive lamivudine. More protracted lamivudine

therapy may be an alternative to close monitoring following chemotherapy,

and further studies are needed to define optimal duration of lamivudine

therapy.

PMID: 15338194 [PubMed - as supplied by publisher]

[Guest guest]

Ann Hematol. 2004 Aug 25 [Epub ahead of print]

Delayed hepatitis B virus reactivation after cessation of preemptive

lamivudine in lymphoma patients treated with rituximab plus CHOP.

Dai MS, Chao TY, Kao WY, Shyu RY, Liu TM.

Division of Hematology/Oncology, Department of Medicine, Tri-Service General

Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Section

2, Neihu 114, Taipei, Taiwan ROC.

Preemptive lamivudine in lymphoma patients undergoing intensive chemotherapy

can effectively prevent chemotherapy-related HBV reactivation. Nevertheless,

the safety profile after withdrawal of lamivudine and the impact of

rituximab-containing chemotherapy on HBV reactivation has not been defined.

To illustrate the necessity of prolonged surveillance after cessation of

preemptive lamivudine in lymphoma patients treated with rituximab and

chemotherapy, four patients with B-cell NHL carrying HBV received rituximab

plus CHOP. Preemptive lamivudine therapy was administered 1 week before

chemotherapy until 4 weeks after completion of chemotherapy. Serial serum

alanine aminotransferase (ALT), total bilirubin, and HBV-DNA levels were

prospectively monitored in three patients. The fourth patient was closely

monitored for ALT. The HBV DNA was checked after development of clinical

overt hepatitis. The peripheral blood CD20(+) B-lymphocyte counts were

analyzed periodically in two patients. All of the three patients studied

prospectively had virological relapses with surgence of HBV DNA 6-8 months

after completion of rituximab-plus-CHOP (R+CHOP) therapy. Two of the three

patients had biochemical relapses and one of them developed severe

hepatitis. Sequencing for HBV polymerase gene in these patients failed to

show evident emergence of lamivudine-resistant mutations. The fourth patient

developed a hepatitis flare-up 6 months after completion of chemotherapy.

The CD20(+) lymphocytes were totally depleted when HBV DNA started to

increase. Delayed HBV reactivation can occur in lymphoma patients receiving

R+CHOP after withdrawal of preemptive lamivudine. More protracted lamivudine

therapy may be an alternative to close monitoring following chemotherapy,

and further studies are needed to define optimal duration of lamivudine

therapy.

PMID: 15338194 [PubMed - as supplied by publisher]

[Guest guest]

Ann Hematol. 2004 Aug 25 [Epub ahead of print]

Delayed hepatitis B virus reactivation after cessation of preemptive

lamivudine in lymphoma patients treated with rituximab plus CHOP.

Dai MS, Chao TY, Kao WY, Shyu RY, Liu TM.

Division of Hematology/Oncology, Department of Medicine, Tri-Service General

Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Section

2, Neihu 114, Taipei, Taiwan ROC.

Preemptive lamivudine in lymphoma patients undergoing intensive chemotherapy

can effectively prevent chemotherapy-related HBV reactivation. Nevertheless,

the safety profile after withdrawal of lamivudine and the impact of

rituximab-containing chemotherapy on HBV reactivation has not been defined.

To illustrate the necessity of prolonged surveillance after cessation of

preemptive lamivudine in lymphoma patients treated with rituximab and

chemotherapy, four patients with B-cell NHL carrying HBV received rituximab

plus CHOP. Preemptive lamivudine therapy was administered 1 week before

chemotherapy until 4 weeks after completion of chemotherapy. Serial serum

alanine aminotransferase (ALT), total bilirubin, and HBV-DNA levels were

prospectively monitored in three patients. The fourth patient was closely

monitored for ALT. The HBV DNA was checked after development of clinical

overt hepatitis. The peripheral blood CD20(+) B-lymphocyte counts were

analyzed periodically in two patients. All of the three patients studied

prospectively had virological relapses with surgence of HBV DNA 6-8 months

after completion of rituximab-plus-CHOP (R+CHOP) therapy. Two of the three

patients had biochemical relapses and one of them developed severe

hepatitis. Sequencing for HBV polymerase gene in these patients failed to

show evident emergence of lamivudine-resistant mutations. The fourth patient

developed a hepatitis flare-up 6 months after completion of chemotherapy.

The CD20(+) lymphocytes were totally depleted when HBV DNA started to

increase. Delayed HBV reactivation can occur in lymphoma patients receiving

R+CHOP after withdrawal of preemptive lamivudine. More protracted lamivudine

therapy may be an alternative to close monitoring following chemotherapy,

and further studies are needed to define optimal duration of lamivudine

therapy.

PMID: 15338194 [PubMed - as supplied by publisher]

[Guest guest]

Ann Hematol. 2004 Aug 25 [Epub ahead of print]

Delayed hepatitis B virus reactivation after cessation of preemptive

lamivudine in lymphoma patients treated with rituximab plus CHOP.

Dai MS, Chao TY, Kao WY, Shyu RY, Liu TM.

Division of Hematology/Oncology, Department of Medicine, Tri-Service General

Hospital, National Defense Medical Center, No. 325, Cheng-Kung Road, Section

2, Neihu 114, Taipei, Taiwan ROC.

Preemptive lamivudine in lymphoma patients undergoing intensive chemotherapy

can effectively prevent chemotherapy-related HBV reactivation. Nevertheless,

the safety profile after withdrawal of lamivudine and the impact of

rituximab-containing chemotherapy on HBV reactivation has not been defined.

To illustrate the necessity of prolonged surveillance after cessation of

preemptive lamivudine in lymphoma patients treated with rituximab and

chemotherapy, four patients with B-cell NHL carrying HBV received rituximab

plus CHOP. Preemptive lamivudine therapy was administered 1 week before

chemotherapy until 4 weeks after completion of chemotherapy. Serial serum

alanine aminotransferase (ALT), total bilirubin, and HBV-DNA levels were

prospectively monitored in three patients. The fourth patient was closely

monitored for ALT. The HBV DNA was checked after development of clinical

overt hepatitis. The peripheral blood CD20(+) B-lymphocyte counts were

analyzed periodically in two patients. All of the three patients studied

prospectively had virological relapses with surgence of HBV DNA 6-8 months

after completion of rituximab-plus-CHOP (R+CHOP) therapy. Two of the three

patients had biochemical relapses and one of them developed severe

hepatitis. Sequencing for HBV polymerase gene in these patients failed to

show evident emergence of lamivudine-resistant mutations. The fourth patient

developed a hepatitis flare-up 6 months after completion of chemotherapy.

The CD20(+) lymphocytes were totally depleted when HBV DNA started to

increase. Delayed HBV reactivation can occur in lymphoma patients receiving

R+CHOP after withdrawal of preemptive lamivudine. More protracted lamivudine

therapy may be an alternative to close monitoring following chemotherapy,

and further studies are needed to define optimal duration of lamivudine

therapy.

PMID: 15338194 [PubMed - as supplied by publisher]