Reactivation of hepatitis B virus in HBsAg-negative patients with multiple myeloma: two case reports

Int J Hematol. 2010 Jun;91(5):844-9. doi: 10.1007/s12185-010-0592-y. Epub 2010 May 15.

Abstract

It was recently reported that hepatitis B virus (HBV) reactivation had occurred in HBsAg-negative lymphoma patients who received rituximab plus steroid combination chemotherapy. HBV reactivation in myeloma patients have not been reported extensively. We describe here two cases of HBV reactivation in HBsAg-negative myeloma patients receiving systemic chemotherapy: one from the medical records of 40 patients and another from 61 patients with prospective HBV-DNA monitoring. In the first case positive for anti-HBs, HBV reactivation was diagnosed when hepatitis developed during conventional chemotherapy such as MP and MCP regimen in a relapsed patient after autologous stem cell transplantation (APBSCT); in the second case positive for anti-HBc and anti-HBs, elevation of HBV-DNA was recognized by serial HBV-DNA monitoring performed prospectively following APBSCT. Interestingly, these two cases had the reduction of the titer of anti-HBs during the treatment, followed by HBV reactivation. These clinical data suggest that the HBV-DNA monitoring is necessary for not only HBsAg-positive but also HBsAg-negative myeloma patients with anti-HBc-positive and/or anti-HBs-positive following transplantation and after conventional chemotherapy in the salvage setting. Establishment of a standard strategy to prevent HBV reactivation is important for myeloma patients receiving systemic chemotherapy.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Dexamethasone / administration & dosage
  • Dexamethasone / therapeutic use
  • Doxorubicin / administration & dosage
  • Doxorubicin / therapeutic use
  • Female
  • Hepatitis B Surface Antigens / immunology
  • Hepatitis B virus / immunology
  • Hepatitis B virus / physiology*
  • Humans
  • Melphalan / administration & dosage
  • Melphalan / therapeutic use
  • Middle Aged
  • Multiple Myeloma / drug therapy
  • Multiple Myeloma / therapy*
  • Multiple Myeloma / virology*
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use
  • Prospective Studies
  • Retrospective Studies
  • Stem Cell Transplantation*
  • Transplantation, Homologous
  • Vincristine / administration & dosage
  • Vincristine / therapeutic use
  • Virus Activation*

Substances

  • Antineoplastic Agents
  • Hepatitis B Surface Antigens
  • Vincristine
  • Dexamethasone
  • Doxorubicin
  • Prednisolone
  • Melphalan