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Blood, 2 April 2009, Vol. 113, No. 14, pp. 3147-3153. Prepublished online as a Blood First Edition Paper on January 14, 2009; DOI 10.1182/blood-2008-10-163493. This Article Full Text (PDF) All Versions of this Article: blood-2008-10-163493v1 113/14/3147    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Liang, R. Search for Related Content PubMed PubMed Citation Articles by Liang, R. Related Collections Related Article in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted October 27, 2008 Accepted January 5, 2009 How I treat and monitor viral hepatitis B infection in patients receiving intensive immunosuppressive therapies or undergoing hematopoietic stem cell transplantation Raymond Liang* Department of Medicine and Centre for Cancer Research, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong * Corresponding author; email: rliang{at}hkucc.hku.hk. Hepatitis B virus (HBV) reactivation is a serious but preventable complication of immunosuppression. Full HBV serological profile must be obtained from all patients receiving chemotherapy, intensive immunosuppressive therapy or hematopoietic stem cell (HSC) transplantation, especially those coming from HBV endemic areas. In general, pre-emptive anti-HBV therapy is more effective than giving treatment after development of reactivation. Prompt lamivudine therapy should be given to at risk patients who are hepatitis B surface antigen (HBsAg) positive. It is recommended that lamivudine be continued until at least six months after the cessation of immunosuppression. This strategy should protect over 90% of them. Some patients may need a longer duration of lamivudine therapy because of prolonged immunosuppression and are at risk of developing drug resistance. They should be closely observed by serum HBV DNA monitoring. The newer anti-HBV agents, such as adevovir, entecavir, telbivudine and tenofovir, are effective in overcoming lamivudine resistance. Early use of these agents may be considered. HBV reactivation has been observed in HBsAg negative patients with occult HBV infection (HBV DNA positive) who are on heavy immunosuppression, especially after receiving monoclonal antibody (rituximab or alemtuzumab) therapy or HSC transplantation. The optimal management of this group of patients is unclear. They may also require pre-emptive anti-HBV therapy. For patients receiving allogeneic HSC transplantation, the HBV status of the donors requires special attention. To minimize the risk of transmission of infection to recipients, HBsAg positive donors should receive adequate anti-HBV therapy prior to HSC donation. The recipients should be closely monitored and given also anti-HBV treatment. As the result of adoptive immune transfer, clearance of HBsAg is observed in HBsAg positive patients receiving HSC transplantation from donors who are positive for hepatitis B surface and core antibodies. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Article in Blood Online: Treatment of viral hepatitis B infection in patients receiving intensive immunosuppressive therapies Philippe Genet, Tahar Touahri, and Veronique Morel Blood 2009 113: 6034. [Full Text] [PDF] This article has been cited by other articles: P. Genet, T. Touahri, and V. Morel Treatment of viral hepatitis B infection in patients receiving intensive immunosuppressive therapies Blood, June 4, 2009; 113(23): 6034 - 6034. [Full Text] [PDF]

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