S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Journal Papers (저널논문_의학과)
Clinical prediction of failure of lamivudine prophylaxis for patients with hepatitis B infection undergoing cytotoxic chemotherapy for malignancy
- Kim, In Kyoung; Kim, Byeong Gwan; Kim, Won; Kim, Donghee; Kim, Yoon Jun; Yoon, Jung-Hwan; Lee, Hyo Suk
- Issue Date
- American Society for Microbiology
- ANTIMICROBIAL AGENTS AND CHEMOTHERAPY Vol.56 No.11, pp. 5511-5519
- Although lamivudine (LAM) prophylaxis is recommended for patients infected with hepatitis B virus (HBV) undergoing chemotherapy
for malignant disease, HBV reactivation sometimes occurs during or after LAM administration. The aim of this study
was to determine predictors of LAM prophylactic failure in patients with malignancies. Patients with malignancies were routinely
screened for serum hepatitis B surface antigen (HBsAg) from June 2002 to August 2008. All consecutive, HBsAg-positive
patients received LAM prophylaxis during and after completion of chemotherapy. We assessed risk factors for virologic breakthrough
and withdrawal hepatitis. Death without HBV reactivation was regarded as a competing risk event, which was adjusted
by Fine and Gray’s model. A total of 110 patients were included in this study. They received LAM prophylaxis for a median of 9.2
months. Virologic breakthrough occurred in 15 patients at a median of 10.9 months from the initiation of LAM prophylaxis.
Withdrawal hepatitis occurred in 15 patients at a median of 2.4 months after cessation of LAM prophylaxis. Multivariable analysis
showed that high baseline HBV DNA titer (>2,000 IU/ml) (hazard ratio [HR], 9.94; P 0.0063) and the use of rituximab
(HR, 3.19; P 0.027) were significant predictors of virologic breakthrough and that high baseline HBV DNA titer (HR, 5.90; P
0.007), liver cirrhosis (HR, 10.4; P 0.002), and distant metastasis (HR, 5.14; P 0.008) were independent risk factors for withdrawal
hepatitis. Patients with high viremia, liver cirrhosis, rituximab treatment, and distant metastasis are at high risk of prophylactic
failure and need antiviral agents with a greater barrier to resistance.
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