Failure of long-term lamivudine prophylaxis in patients with resolved hepatitis B infection undergoing chemotherapy and allogenic hematopoietic stem cell transplantation for hematological malignancies: two case reports

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Failure of long-term lamivudine prophylaxis in patients with resolved hepatitis B infection undergoing chemotherapy and allogenic hematopoietic stem cell transplantation for hematological malignancies: two case reportsHepatitis B virus (HBV) reactivation is a well known complication in patients with resolved HBV infection, i.e., HBsAg negative, hepatitis B core antibody (anti-HBc) positive ± antibodies against HBsAg (anti-HBs), undergoing chemotherapy (CT) and/or allogenic hematopoietic stem cell transplantation (HSCT) for onco-hematological diseases.[1][2][3] In these patients, this risk can be prevented by either "pre-emptive anti-HBV therapy", based on the monitoring of HBV DNA and/or HBsAg, followed by rescue therapy with anti-HBV regimens, or by "anti-HBV prophylaxis" based on the administration of nucleos(t)ides analogs (NUCs) during immunosuppression and for a consolidation time after the end of immunosuppressive drugs.As per standard procedure in our centre, all patients with hematological malignancies and a resolved HBV infection receive lamivudine (LMV) prophylaxis at the time of CT or HSCT to be maintained for at least 18 months after the discontinuation of immunosuppressive drugs.