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Chemotherapy and Bone Marrow Transplantation for Cancer Patients Who Are Also Chronic Hepatitis B Carriers: A Review of the Problem

ABSTRACT

In places where hepatitis B virus (HBV) infection is endemic, itis often necessary to give chemotherapy to or perform bone marrowtransplantation for cancer patients who are also chronic HBV carriers.When standard chemotherapy was given to lymphoma patients, elevation ofliver transaminases was observed in nearly half of those who werechronic HBV carriers. Ten percent of them became jaundiced, and theoverall liver-related mortality was about 5%. There is currently noreliable way to predict the severity of HBV reactivation afterchemotherapy. The risk is probably higher when the chemotherapy used issignificantly immunosuppressive and the viral load in the liver ishigh. Different strategies have been used in an attempt to reduce therisk of HBV reactivation after chemotherapy, but they have not beenvery successful. Further studies will be required to determine theimpact of newly available antiviral agents that are active against HBV.

Recipients who are carriers of HBV or who receive hepatitis B surfaceantigen (HBsAg)-positive marrow are at increased risk of hepatitisB-related morbidity and mortality after bone marrow transplantation(BMT). There is evidence to suggest that prophylactic use of an activeantiviral agent, such as famciclovir, may result in a significantdecrease in the incidence and severity of HBV reactivation after BMT.Sustained serologic clearance of chronic HBV infection has also beenreported in many HBsAg-positive marrow recipients receiving hepatitis Bsurface antibody-positive marrow from their allogeneic donors. Thereseems to be a transfer of both humoral and cellular immunity againstHBV from donors to recipients.

Further prospective studies are required to define the best approach tomanage HBsAg-positive cancer patients receiving chemotherapy or BMT. Itis recommended that all cancer patients be checked for their hepatitisB status before receiving chemotherapy or a bone marrow transplant,especially if they reside in or come from endemic areas of HBVinfection.

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