International Journal of Hematology

, Volume 91, Issue 5, pp 844–849

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

  • Tatsuya Yoshida
  • Shigeru Kusumoto
  • Atsushi Inagaki
  • Fumiko Mori
  • Asahi Ito
  • Masaki Ri
  • Takashi Ishida
  • Hirokazu Komatsu
  • Shinsuke Iida
  • Fuminaka Sugauchi
  • Yasuhito Tanaka
  • Masashi Mizokami
  • Ryuzo Ueda
Original Article

DOI: 10.1007/s12185-010-0592-y

Cite this article as:
Yoshida, T., Kusumoto, S., Inagaki, A. et al. Int J Hematol (2010) 91: 844. doi:10.1007/s12185-010-0592-y

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.

Keywords

ReactivationHBVMyelomaTransplantation

Abbreviations

HBV

Hepatitis B virus

HBsAg

Hepatitis B surface antigen

Anti-HBc

Hepatitis B core antibody

Anti-HBs

Hepatitis B surface antibody

AST

Aspartate transaminase

ALT

Alanine aminotransferase

RTD-PCR

Real-time detection polymerase chain reaction

APBSCT

Autologous peripheral blood stem cell transplantation

VAD

Vincristine, doxorubicin, dexamethasone

MP

Melphalan, prednisolone

MCP

Ranimustine, cyclophosphamide, prednisolone

MMCP

Melphalan, ranimustine, cyclophosphamide, prednisolone

BD

Bortezomib, dexamethasone

TD

Thalidomide, dexamethasone

CHOP

Cyclophosphamide, doxorubicin, vincristine, prednisolone

R-CHOP

Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone

Copyright information

© The Japanese Society of Hematology 2010

Authors and Affiliations

  • Tatsuya Yoshida
    • 1
  • Shigeru Kusumoto
    • 1
  • Atsushi Inagaki
    • 1
  • Fumiko Mori
    • 1
  • Asahi Ito
    • 1
  • Masaki Ri
    • 1
  • Takashi Ishida
    • 1
  • Hirokazu Komatsu
    • 1
  • Shinsuke Iida
    • 1
  • Fuminaka Sugauchi
    • 2
  • Yasuhito Tanaka
    • 2
  • Masashi Mizokami
    • 3
  • Ryuzo Ueda
    • 1
  1. 1.Department of Medical Oncology and ImmunologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
  2. 2.Department of Virology and Liver UnitNagoya City University Graduate School of Medical SciencesNagoyaJapan
  3. 3.Research Center for Hepatitis and ImmunologyInternational Medical Center of Japan Konodai HospitalIchikawaJapan