Reactivation of hepatitis B virus in HBsAg-negative patients with multiple myeloma: two case reports
Reactivation of hepatitis B virus in HBsAg-negative patients with multiple myeloma: two case reports
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DOI：
10.1007/s12185-010-0592-y
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发表时间：
2010-06-01
影响因子：
2.1
通讯作者：
Ueda, Ryuzo
中科院分区：
文献类型：
--
作者：
Yoshida, Tatsuya;Kusumoto, Shigeru;Ueda, Ryuzo
最近有报道称，接受利妥昔单抗加类固醇联合化疗的 HBsAg 阴性淋巴瘤患者发生了乙型肝炎病毒 (HBV) 再激活。骨髓瘤患者的 HBV 再激活尚未得到广泛报道。我们在这里描述了接受全身化疗的 HBsAg 阴性骨髓瘤患者中 HBV 再激活的两例：一例来自 40 名患者的医疗记录，另一例来自 61 名进行前瞻性 HBV-DNA 监测的患者。在第一例抗-HBs阳性的病例中，在自体干细胞移植（APBSCT）后复发的患者中，在常规化疗（例如MP和MCP方案）期间出现肝炎时，诊断出HBV再激活；在第二例抗 HBc 和抗 HBs 呈阳性的病例中，通过 APBSCT 后前瞻性进行的系列 HBV-DNA 监测发现 HBV-DNA 升高。有趣的是，这两个病例在治疗期间抗-HBs滴度降低，随后乙型肝炎病毒重新激活。这些临床数据表明，HBV-DNA 监测不仅对于 HBsAg 阳性，而且对于移植后和挽救环境中常规化疗后抗 HBc 阳性和/或抗 HBs 阳性的 HBsAg 阴性骨髓瘤患者也是必要的。建立预防 HBV 再激活的标准策略对于接受全身化疗的骨髓瘤患者非常重要。
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.