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Hepatitis B virus reactivation and alemtuzumab therapy

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Iannitto E, Minardi V, Calvaruso G, Mulè A, Ammatuna E, Trapani RD, Ferraro D, Abbadessa V, Craxí A, Stefano RD. Hepatitis B virus reactivation and alemtuzumab therapy.

Eur J Haematol 2005: 74: 254–258. © Blackwell Munksgaard 2005. Abstract: 

Reactivation of hepatitis B virus infection in subjects receiving cytotoxic treatment for heamatological malignancies occurs in 21–53% of chronic HBsAg carriers and in an unknown number of HBsAg negative subjects harbouring occult HBV infection. Immunotherapy with alemtuzumab, a humanized monoclonal antibody against CD52 epitopes on lymphocytes cells produces deep immunosuppression. We describe two subjects with chronic lymphocytic leukaemia and occult HBV infection who developed a virological and biochemical flare of hepatitis B following immunotherapy with alemtuzumab. One of them developed full blown hepatitis with seroreversion from anti-HBs to HBsAg after four weeks of alemtuzumab therapy. Lamivudine (100 mg die) achieved a complete clinical recovery and HBV-DNA clearance from blood within 8 weeks. The second patient (HBsAg and HBV-DNA seronegative, anti-HBs and anti-HBc positive before treatment) was kept under prophylaxis with lamivudine up to three months after alemtuzumab. Two months after withdrawal of lamivudine, clinical and laboratory features of acute hepatitis B developed. Lamivudine therapy was restarted and a prompt recovery was obtained with HBsAg and HBV-DNA clearance.
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Keywords: Alemtuzumab; Campath-1H; acute hepatitis; chronic lymphocytic leukaemia; hepatitis B virus; lamivudine

Document Type: Research Article

Affiliations: 1: Department of Oncology, Haematology, and BMT Unit 2: Department of Hygiene and Microbiology 3: Department of Biomedical Sciences, Gastroenterology Section, University of Palermo, Palermo, Italy

Publication date: March 1, 2005

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