Hepatitis B reactivation after thalidomide.

摘要

We read with interest the recent article by Lubel et al. on guidelines for prevention and management of hepatitis B virus (HBV) reactivation following immunosuppressive therapy, in which lamivudine prophylaxis after chemotherapy in all at risk patients was recommended. Not specifically mentioned in this article was HBV reactivation after single agent therapy with fludarabine, widely used in Australia in patients with low-grade non-Hodgkin lymphoma, or thalidomide, which is now Pharmaceutical Benefits Scheme, listed for patients with relapsed or refractory myeloma. Thalidomide has various and opposing immunomodulatory effects, including down regulation of tumour necrosis factor-alpha and stimulation of interleukin-12-secreting T cells and has been associated with disseminated Herpes simplex virus (HSV) and varicella zoster virus (VZV) infection. There are no published recommendations on the management of patients at risk of HBV reactivation receiving thalidomide and no data on the optimal duration of ongoing lamivudine prophylaxis after thalidomide is ceased. We report a case of HBV reactivation occurring shortly after the simultaneous cessation of thalidomide and prophylactic lamivudine, suggesting that prolonged prophylaxis is indicated.