Reactivation of hepatitis B virus infection with cytotoxic therapy in non-Hodgkin’s lymphoma
Received: 08 September 2003 Revised: 11 October 2003 Accepted: 11 October 2003 DOI:
10.1385/MO:21:1:67 Cite this article as: Ozguroglu, M., Bilici, A., Turna, H. et al. Med Oncol (2004) 21: 67. doi:10.1385/MO:21:1:67 Abstract
In patients with non-Hodgkin’s lymphoma (NHL), there are some well-known tumor-related adverse prognostic factors that may increase the mortality rate. However, secondary factors such as viral hepatitis carriers that may decrease the cure rates are usually ignored. Reactivation of hepatitis B virus (HBV) infection in patients undergoing cytotoxic treatment for NHL is a well-known complication. Charts of 112 patients with NHL were retrospectively analyzed regarding their hepatitis serology, the indirect effects of seropositivity on disease outcome, and the precautions undertaken in these seropositive patients with NHL. Twelve patients (11%) with HBsAg positivity and two patients (1.7%) with antibody to hepatitis C virus positivity were detected. Eight out of 12 patients (67%) with HBsAg positivity and two patients (50%) with anti-HCV positivity showed reactivation of hepatitis during treatment of NHL. No reactivation was detected in four patients seropositive for HBV, who were given lamivudine prophylaxis before the initiation of chemotherapy schedules. Among patients with hepatitis reactivation, two were treated with lamivudine resulting in dramatic improvement and clinical remission of the disease. The remaining six patients with reactivation were left untreated, resulting in four deaths (67%) due to liver failure secondary to HBV and two deaths secondary to delayed treatment of NHL. One patient seropositive for anti-HCV also developed chronic hepatitis C. Determination of hepatitis serology in all patients with NHL before any chemotherapy administration is crucial, but insufficient, if not taken into consideration. In seropositive patients, HBV DNA should be determined and antiviral prophylaxis with lamivudine should be initiated before any treatment.
Key Words Non-Hodgkin’s lymphoma hepatitis B virus reactivation chemotherapy lamivudine References
Lau JYN, et al. Fatal reactivation of chronic hepatitis B virus infection following withdrawal of chemotherapy in lymphoma patients.
Q J Med
Lok ASF, Liang RHS, Chiu EKW, Wong KL, Chan TW, Todd D. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy.
Soh LT, Ang PT, Chua EJ, Ong YW. Fulminant hepatic failure in Non-Hodgkin lymphoma patients treated with chemotherapy.
Eur J Cancer
Wands JR. Subacute and chronic active hepatitis after with-drawal of chemotherapy.
Hoofnagle JH, Dusheiko GM, Schafer DF. Reactivation of chronic hepatitis B virus infection by cancer chemotherapy.
Ann Intern Med
Clark FL, Drummond MW, Chambers S, Champman BA, Patton WN. Successful treatment with lamivudine for fulminant reactivated hepatitis B infection following intensive therapy for high-grade Non-Hodgkin lymphoma.
Al-Taie OH, Mork H, Gassel AM, Wilhelm M, Weissbrich B, Scheurlen M. Prevention of hepatitis B flare-up during chemotherapy using lamivudine: case report and review of the literature.
Musolino C, Campo S, Pollicino T, Squadrito G, Spatari G, Raimondo G. Evaluation of hepatitis B and C virus infections in patients with non-Hodgkin lymphoma and without liver disease.
Gasztonyi B, et al. Hepatitis C virus infection associated with B-cell non-Hodgkin lymphoma in Hungarian patients.
Br J Haematol
De Rosa G, et al. High prevalence of hepatitis C virus infection in patients with B-cell lymphoproliferative disorders in Italy.
Am J Hematol
Persico M, et al. Efficacy of lamivudine to prevent hepatitis reactivation in hepatitis B virus-infected patients treated for non-Hodgkin lymphoma.
Kaneko S, Miller RH, Feinstone SM, Hoofnagle JH, Purcell RH. Detection of hepatitis B virus DNA in serum by polymerase chain reaction.
Kumagai K, et al. Hepatitis B virus carriers in the treatment of malignant lymphoma: an epidemiological study in Japan.
(suppl 1): 107–109.
Nokamura V, Motokura T, Fujita A, Vamashita T, Ogata E. Severe hepatitis related to chemotherapy in hepatitis B virus carriers with hematologic malignancies.
Cancer 1996; 78:2270–2275.
Yeo W, et al. Frequency of hepatitis B virus reactivation in cancer patients undergoing cytotoxic chemotherapy.
J Med Virol
Markovic S, Drozina G, Vovk M, Fidler-Jenko M. Reactivation of hepatitis B but not hepatitis C in patients with malignant lymphoma and immunosuppressive therapy. A prospective study in 305 patients.
Kawai Y, et al. Successful lamivudine therapy for post-chemotherapeutic fulminant hepatitis B in a hepatitis B virus carrier with non-Hodgkin’s lymphoma: case report and review of the literature.
Yoshiba M, Sekiyama K, Sugata F, Okamoto H, Yamamoto K, Yotsumato S. Reactivation of precore mutant hepatitis virus leading to fulminant hepatic failure following cytotoxic treatment.
Dig Dis Sci
Ahmed A, Keeffe EB. Lamivudine therapy for chemotherapy-induced reactivation of hepatitis B virus infection.
Am J Gastroenterol
Yeo W, et al. Lamivudine in the treatment of hepatitis B virus reactivation during cytotoxic chemotherapy.
J Med Virol
Silvestri F, et al. Lamivudine allows completion of chemotherapy in lymphoma patients with hepatitis B reactivation.
Br J Haematol
Stroffolini T, Andriani A, Bibas M, Barlattani A. Successful treatment with lamivudine for reactivated hepatitis B infection following chemotherapy for non-Hodgkin lymphoma.
Liao CA, Lee CM, Wu HC, Wang MC, Lu SN, Eng HL. Lamivudine for the treatment of hepatitis B virus reactivation following chemotherapy for non-Hodgkin’s lymphoma.
Br J Haematol
Saif MW, Little RF, Hamilton JM, Allegra CJ, Wilson WH. Reactivation of chronic hepatitis B infection following intensive chemotherapy and successful treatment with lamivudine: A case report and review of the literature.
Rossi G, Pelizzari A, Motta M, Puoti M. Primary prophylaxis with lamivudine of hepatitis B virus reactivation in chronic HbsAg carriers with lymphoid malignancies treated with chemotherapy.
Br J Haematol
Dienstag JL, Perrillo RP, Schiff ER, Bartholomew M, Vicary C, Rubin M. A preliminary trial of lamivudine for chronic hepatitis B infection.
N Engl J Med
Lai CL, et al. A one-year course of lamivudine for chronic hepatitis B.
N Engl J Med
Ohtsu T, Sai T, Oka M, Sugai Y, Tobiani K. Activation of hepatitis B virus carriers with hematological malignancies.
Jpn J Clin Oncol
Cheng AL. Steroid-free chemotherapy decreases the risk of hepatitis flare-up in hepatitis B virus carriers with non-Hodgkin’s lymphoma.
Chemotherapy and hepatitis B (editorial).
Lancet 1989; 2:1136–1137.
Vento S, Cainelli F, Mirandola F, Cosco L, Di Peri G, Solbiati M. Fulminant hepatitis on withdrawal of chemotherapy in carriers of hepatitis C virus.