Hepatitis 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.31 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.
Herein, we describe two patients with resolved HBV infection who, following allogenic HSCT and repeated cycles of CT for hematological malignancies, developed HBsAg seroreversion due to the late emergence of LMV-resistance (R) during long-term LMV prophylaxis.
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