Hepatitis B virus (HBV) reactivation is well documented in infected patients who have
hematologic malignancies, precluding appropriate
chemotherapy courses and, therefore, increasing the possibility of relapse of
malignancies. The objective of this study was to evaluate
lamivudine treatment to prevent
hepatitis B reactivation in children with
cancer who acquired
infection with HBV and so allow completion of optimal
chemotherapy. Ten children (7:3 M:F; median age: 9.8 years), undergoing
chemotherapy for
hematological malignancies and suffering from immunosuppressive-induced hepatitis B virus reactivation, were treated concurrently with
lamivudine (3 mg/kg bw, od) for up to 18 months. All were HBsAg+ve, HBsAb-ve, HBV-DNA+ve. Serology markers (
HBsAg/Ab,
HBeAg/Ab, HBV-
DNA) and ALT were tested 3 monthly. Histological assessments were performed pre- and 18 months post-
lamivudine therapy. During
lamivudine therapy chemotherapy courses were completed for all children, and none of the patients suffered reactivation of
hepatitis. After a median follow-up of 10 months, remission of
malignancy was maintained in 7/10 patients while 3 patients relapsed. HBeAg+ve seroconversion occurred in 4/9 HBeAg+ve children within 3 months. After 9 months of
therapy, 8/10 were HBV-
DNA-ve. Six out of 7 children with histological evidence of
chronic hepatitis showed marked improvement post-
therapy.
Lamivudine therapy for up to 18 months in children receiving
chemotherapy helped prevent recurrence of
hepatitis B exacerbations and improved the underlying
chronic hepatitis, while facilitating completion of appropriate
chemotherapy regimens without compromise.