Steroid-free chemotherapy decreases risk of hepatitis B virus (HBV) reactivation in HBV-carriers with lymphoma
Steroid-free chemotherapy decreases risk of hepatitis B virus (HBV) reactivation in HBV-carriers with lymphoma
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DOI：
10.1053/jhep.2003.50220
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发表时间：
2003-06-01
期刊：
影响因子：
13.5
通讯作者：
Whang-Peng, J
中科院分区：
文献类型：
--
作者：
Cheng, AL;Hsiung, CA;Whang-Peng, J
肝炎再活化是淋巴瘤患者化疗的最严重并发症之一，这些患者是肝炎B病毒（HBV）携带者。糖皮质激素与HBV再激活风险增加有关。本研究旨在阐明从化疗方案中去除糖皮质激素是否可以降低HBV再激活的风险。符合条件的患者为B型肝炎表面抗原（HBsAg）血清阳性，并经组织学证实为非霍奇金淋巴瘤，需要进行强化化疗。患者随机接受ACE（表阿霉素、环磷酰胺和依托泊苷）或PACE（泼尼松龙+ ACE）治疗。共入组50例患者，ACE和PACE组各25例。化疗开始后9个月，ACE和PACE组HBV再激活的累积发生率分别为38%和73%（P = 0.03）。PACE组的临床肝炎程度明显更严重：PACE组11例患者（44%）和ACE组3例患者（13%）ALT升高超过正常值的10倍（P = 0.025），PACE组7例患者（28%）和ACE组1例患者（4%）发生黄疸型肝炎（P = 0.049）。PACE组11例（46%）患者和ACE组8例（35%）患者的肿瘤完全缓解（P = 0.556）。PACE组和ACE组46个月时的估计总生存率分别为68%和36%（P = 0.18）。总之，无激素化疗可降低HBeAg阳性淋巴瘤患者HBV再激活的发生率和严重程度。然而，需要进一步的研究，以评估是否类固醇无化疗可能赋予一个不太令人满意的控制淋巴瘤。
Reactivation of hepatitis is one of the most serious complications of chemotherapy in lymphoma patients who are carriers of the hepatitis B virus (HBV). Glucocorticoids are linked to increased risk of HBV reactivation. This study seeks to clarify whether removal of glucocorticoids from chemotherapy regimens may decrease the risk of HBV reactivation. Eligible patients were seropositive for hepatitis B surface antigen (HBsAg) and had histologically proven non-Hodgkin's lymphomas for which intensive chemotherapy was indicated. Patients were randomized to receive either ACE (epirubicin, cyclophosphamide, and etoposide) or PACE (prednisolone + ACE). A total of 50 patients were enrolled, 25 each for the ACE and PACE arms. The cumulative incidence of HBV reactivation at 9 months after starting chemotherapy was 38% and 73% for ACE and PACE arm, respectively (P =.03). The degree of clinical hepatitis was significantly more severe in the PACE arm: 11 patients (44%) in the PACE and 3 patients (13%) in the ACE arm had ALT elevation more than 10-fold of normal (P =.025), and 7 patients (28%) in the PACE and 1 patient (4%) in the ACE arm had icteric hepatitis (P =.049). Complete remission of tumors occurred in 11 (46%) patients in the PACE and 8 (35%) patients in the ACE arm (P =.556). The estimated overall survival rate at 46 months was 68% in the PACE arm and 36% in the ACE arm, respectively (P = .18). In conclusion, steroid-free chemotherapy decreases the incidence and severity of HBV reactivation in HBsAg-positive lymphoma patients. However, further research is needed to evaluate whether steroid-free chemotherapy may confer a less satisfactory control of lymphoma.