Clinical-liver, pancreas, and biliary tractEarly is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy☆
Section snippets
Patients studied
From February 2001 to March 2003, 402 adult lymphoma patients were treated with high-dose chemotherapy at Queen Mary Hospital and Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China. In accordance with our standard protocols for lymphoma patients treated with chemotherapy, all patients were screened for HBsAG, hepatitis B surface antibody, hepatitis C virus antibody (anti-HCV), and human immunodeficiency virus antibody before chemotherapy. For all HBsAG-positive patients,
Patient characteristics
There were no statistical differences between the 2 groups in terms of sex, age, underlying hematologic diseases, baseline serum ALT, bilirubin, HBeAG status, serum HBV DNA level (by Digene Hybrid Capture II assay), HBV genotype, or the presence of (A1896) and basal core promoter (T1762/A1764) variants (Table 1).
Hepatitis after chemotherapy
Twenty-nine patients survived the entire period of the study: there was 1 death due to uncontrolled lymphoma and disseminated sepsis in group 2. Two patients in group 1 received bone
Discussion
Effective anti-HBV nucleoside analogues, such as lamivudine, are now available for treatment of hepatitis due to HBV reactivation in HBsAG-positive subjects undergoing intense chemotherapy.5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 The optimal time for its initiation remains uncertain.23 The initiation of antiviral treatment only after there are major biochemical abnormalities is not entirely satisfactory. This may not be effective in reducing liver injury by this time,8, 10 because
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Supported in part by Glaxo-SmithKline Pharmaceuticals (GSK NUC30939). This project was supported by a grant from the Cheng Si-yuan (China-International) Hepatitis Research Foundation (to the University of Hong Kong), a China National 973 research grant (Grant 1999 054105 [to G.K.K.L.]), an ear-marked grant from the Hong Kong Research Grant Council, and a grant from the University Research Committee (to R.L.).