• Emilio Iannitto, Viviana Minardi, Giuseppina Calvaruso, Antonino Mulè, Emanuele Ammatuna, Rosa Di Trapani, Rosa D Trapani, Donatella Ferraro, Vincenzo Abbadessa, Antonio Craxí, Rosa Di Stefano, and Rosa D Stefano.
• Department of Oncology, Haematology, and BMT Unit, University of Palermo, Palermo, Italy. eiannito@tin.it
• Eur. J. Haematol. 2005 Mar 1; 74 (3): 254-8.

AbstractReactivation of hepatitis B virus infection in subjects receiving cytotoxic treatment for heamatological malignancies occurs in 21-53% of chronic HBsAg carriers and in an unknown number of HBsAg negative subjects harbouring occult HBV infection. Immunotherapy with alemtuzumab, a humanized monoclonal antibody against CD52 epitopes on lymphocytes cells produces deep immunosuppression. We describe two subjects with chronic lymphocytic leukaemia and occult HBV infection who developed a virological and biochemical flare of hepatitis B following immunotherapy with alemtuzumab. One of them developed full blown hepatitis with seroreversion from anti-HBs to HBsAg after four weeks of alemtuzumab therapy. Lamivudine (100 mg die) achieved a complete clinical recovery and HBV-DNA clearance from blood within 8 weeks. The second patient (HBsAg and HBV-DNA seronegative, anti-HBs and anti-HBc positive before treatment) was kept under prophylaxis with lamivudine up to three months after alemtuzumab. Two months after withdrawal of lamivudine, clinical and laboratory features of acute hepatitis B developed. Lamivudine therapy was restarted and a prompt recovery was obtained with HBsAg and HBV-DNA clearance.

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