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

• Published in: International journal of hematology 2010-06, Vol.91 (5), p.844-849
• Main Authors: Yoshida, Tatsuya, Kusumoto, Shigeru, Inagaki, Atsushi, Mori, Fumiko, Ito, Asahi, Ri, Masaki, Ishida, Takashi, Komatsu, Hirokazu, Iida, Shinsuke, Sugauchi, Fuminaka, Tanaka, Yasuhito, Mizokami, Masashi, Ueda, Ryuzo
• Format: Article
• Language: English
• Subjects: Antineoplastic Agents - administration & dosage; Antineoplastic Agents - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Dexamethasone - administration & dosage; Dexamethasone - therapeutic use; Doxorubicin - administration & dosage; Doxorubicin - therapeutic use; Female; Hematologic and hematopoietic diseases; Hematology; Hepatitis B Surface Antigens - immunology; Hepatitis B virus; Hepatitis B virus - immunology; Hepatitis B virus - physiology; Humans; Immunodeficiencies. Immunoglobulinopathies; Immunoglobulinopathies; Immunopathology; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Medicine; Medicine & Public Health; Melphalan - administration & dosage; Melphalan - therapeutic use; Middle Aged; Multiple Myeloma - drug therapy; Multiple Myeloma - therapy; Multiple Myeloma - virology; Oncology; Original Article; Prednisolone - administration & dosage; Prednisolone - therapeutic use; Prospective Studies; Retrospective Studies; Stem Cell Transplantation; Transplantation, Homologous; Vincristine - administration & dosage; Vincristine - therapeutic use; Virus Activation
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-010-0592-y

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.