Lamivudine prophylaxis reduces the incidence and severity of hepatitis in hepatitis B virus carriers who receive chemotherapy for lymphoma

• Published in: Cancer 2006-03, Vol.106 (6), p.1320-1325
• Main Authors: Li, Yu‐Hong, He, Yi‐Fu, Jiang, Wen‐Qi, Wang, Fen‐Hua, Lin, Xu‐Bin, Zhang, Li, Xia, Zhong‐Jun, Sun, Xiao‐Fei, Huang, Hui‐Qiang, Lin, Tong‐Yu, He, You‐Jian, Guan, Zhong‐Zhen
• Format: Article
• Language: English
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Anthracyclines - therapeutic use; Anti-HIV Agents - administration & dosage; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiviral agents; Biological and medical sciences; Child; Dose-Response Relationship, Drug; Female; hepatitis; Hepatitis B - epidemiology; Hepatitis B - prevention & control; Hepatitis B virus; Hepatitis B virus - drug effects; Hepatitis B virus - isolation & purification; hepatitis B virus carrier; Hodgkin Disease - drug therapy; Hodgkin Disease - pathology; Humans; Incidence; lamivudine; Lamivudine - administration & dosage; lymphoma; Lymphoma, Non-Hodgkin - drug therapy; Lymphoma, Non-Hodgkin - pathology; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Pharmacology. Drug treatments; Primary Prevention; Prognosis; Survival Rate; Treatment Outcome; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.21701

BACKGROUND Hepatitis B virus (HBV) infection is a common disease in China. Severe hepatitis is a well recognized complication in HBV carriers with malignant disease who receive cytotoxic chemotherapy. The objective of the current study was to assess the value of antiviral lamivudine for reducing the incidence and severity of hepatitis in HBV carriers with lymphoma who receive chemotherapy. METHODS Two groups were compared in this nonrandomized study. The prophylactic lamivudine group was comprised of 40 patients who received oral lamivudine at a dose of 100 mg daily before and until at least 8 weeks after they discontinued chemotherapy. The historic control group was comprised of 116 patients who received chemotherapy without lamivudine. The incidence and severity of hepatitis and other adverse clinical outcomes were compared between the two groups. Significant prognostic factors for the development of hepatitis were determined based on data derived from the control group. RESULTS The two groups were comparable in most clinical baseline characteristics, including gender distribution, age, tumor types, primary treatment, hepatitis Be antigen status, and the use of anthracyclines or/and prednisone. In the prophylactic lamivudine group, there was significantly less incidence of hepatitis (17.5% vs. 51.7% in the control group; P = 0.000); less severe hepatitis (according to World Health Organization [WHO] criteria) (10% with Grade 1, 5% with Grade 2, and 2.5% with Grade 3 hepatitis vs. 3.4% with Grade 1, 12.1% with Grade 2, 12.9% with Grade 3, and 23.3% with Grade 4 hepatitis in the control group; P = 0.000); and less disruption of chemotherapy (10.0% vs. 37.1% in the control group; P = 0.001). The overall mortality as a result of hepatitis in the prophylactic lamivudine group was lower compared with that in the control group, but the difference was not statistically significant (0.0% vs. 5.2%; P = 0.163). In the control group, the factor associated with a greater risk of developing hepatitis was the use of prednisone. In the prophylactic lamivudine group, 1 of 40 patients (2.5%) developed hepatitis that was attributable to HBV reactivation. Further examination demonstrated that this single patient had a variation of HBV with YMDD mutations after the use of lamivudine for 9.2 months. CONCLUSIONS The results of the current study confirmed previous reports that lamivudine prophylaxis significantly reduced the incidence and severity of hepatitis in HBV carriers w