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

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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.

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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

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Acknowledgments

Financial support was provided by the Ministry of Health, Labour and Welfare of Japan (Grant-in-Aid H20-kanen-014 to S.K.).

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Authors and Affiliations

  1. Department of Medical Oncology and Immunology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-chou, Mizuho-ku, Nagoya, 467-8601, Japan

    Tatsuya Yoshida, Shigeru Kusumoto, Atsushi Inagaki, Fumiko Mori, Asahi Ito, Masaki Ri, Takashi Ishida, Hirokazu Komatsu, Shinsuke Iida & Ryuzo Ueda

  2. Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Fuminaka Sugauchi & Yasuhito Tanaka

  3. Research Center for Hepatitis and Immunology, International Medical Center of Japan Konodai Hospital, Ichikawa, Chiba, Japan

    Masashi Mizokami

Authors
  1. Tatsuya Yoshida
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  2. Shigeru Kusumoto
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  3. Atsushi Inagaki
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  4. Fumiko Mori
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  5. Asahi Ito
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  6. Masaki Ri
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  7. Takashi Ishida
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  8. Hirokazu Komatsu
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  9. Shinsuke Iida
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  10. Fuminaka Sugauchi
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  11. Yasuhito Tanaka
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  12. Masashi Mizokami
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  13. Ryuzo Ueda
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Corresponding author

Correspondence to Shigeru Kusumoto.

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Yoshida, T., Kusumoto, S., Inagaki, A. et al. Reactivation of hepatitis B virus in HBsAg-negative patients with multiple myeloma: two case reports. Int J Hematol 91, 844–849 (2010). https://doi.org/10.1007/s12185-010-0592-y

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  • DOI: https://doi.org/10.1007/s12185-010-0592-y

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