Antineoplastics
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Reactions 1218 - 6 Sep 2008 S Antineoplastics Hepatitis B reactivation: 2 case reports Two patients experienced reactivation of hepatitis B virus (HBV) infection following treatment with the rituximab- containing antineoplastic regimen R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone/ prednisolone * [dosages not stated]); patient 1 subsequently died. Patient 1, a 68-year-old woman with large B-cell lymphoma, received six courses of R-CHOP. After 1 year, while in remission, she presented with a respiratory infection. Laboratory findings at this time showed an AST level of 109 UI/L, an ALT level of 88 UI/L, a GGT level of 221 UI/L, a bilirubin level of 0.9 mg/dL and a LDH level of 536 UI/L. Despite negative viral serology, she began receiving lamivudine. Her liver function tests worsened over the following week reaching an AST level of 153 UI/L, an ALT level of 97 UI/L, a GGT level of 815 UI/L, a bilirubin level of 14 mg/dL and a LDH level of 342 UI/L. Serology was HBsAg and HBeAg positive, consistent with HBV reactivation. Her condition continued to deteriorate with liver and renal dysfunction leading to multiple organ failure and death. Patient 2, a 53-year-old woman with follicular lymphoma, received three courses of R-CHOP. Nine months later, while in complete remission, asymptomatic liver dysfunction was noted. She had an AST level of 177 UI/L, an ALT level of 177 UI/L, a GGT level of 201 UI/L, a bilirubin level of 1.2 mg/dL and a LDH level of 495 UI/L. Despite serology showing only resolved HBV infection she received lamivudine. Later tests confirmed reactivation of HBV (HBsAg and HBeAg positive with a HBV-DNA level of 3120 pg/mL). After 7 months, she developed pancreatitis which resolved following cessation of lamivudine. Treatment resumed with entecavir. Three months later she remained asymptomatic with a declining HBV-DNA level and a slight improvement in her liver function. Author comment: "Rituximab induces profound and durable B-cell depletion. This may account for the increasing incidence of HBV reactivation in HBsAg-negative patients." * It is not specified whether the patients were receiving prednisone or prednisolone as part of R-CHOP Garcia-Rodriguez MJ, et al. Late reactivation of resolved hepatitis B virus infection: an increasing complication post rituximab-based regimens treatment? American Journal of Hematology 83: 673-675, No. 8, Aug 2008 - Spain 801117780 1 Reactions 6 Sep 2008 No. 1218 0114-9954/10/1218-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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Transcript of Antineoplastics
Reactions 1218 - 6 Sep 2008
SAntineoplastics
Hepatitis B reactivation: 2 case reportsTwo patients experienced reactivation of hepatitis B virus
(HBV) infection following treatment with the rituximab-containing antineoplastic regimen R-CHOP (rituximab,cyclophosphamide, doxorubicin, vincristine and prednisone/prednisolone* [dosages not stated]); patient 1 subsequentlydied.
Patient 1, a 68-year-old woman with large B-cell lymphoma,received six courses of R-CHOP. After 1 year, while inremission, she presented with a respiratory infection.Laboratory findings at this time showed an AST level of109 UI/L, an ALT level of 88 UI/L, a GGT level of 221 UI/L, abilirubin level of 0.9 mg/dL and a LDH level of 536 UI/L.Despite negative viral serology, she began receivinglamivudine. Her liver function tests worsened over thefollowing week reaching an AST level of 153 UI/L, an ALT levelof 97 UI/L, a GGT level of 815 UI/L, a bilirubin level of 14 mg/dLand a LDH level of 342 UI/L. Serology was HBsAg and HBeAgpositive, consistent with HBV reactivation. Her conditioncontinued to deteriorate with liver and renal dysfunctionleading to multiple organ failure and death.
Patient 2, a 53-year-old woman with follicular lymphoma,received three courses of R-CHOP. Nine months later, while incomplete remission, asymptomatic liver dysfunction wasnoted. She had an AST level of 177 UI/L, an ALT level of177 UI/L, a GGT level of 201 UI/L, a bilirubin level of 1.2 mg/dLand a LDH level of 495 UI/L. Despite serology showing onlyresolved HBV infection she received lamivudine. Later testsconfirmed reactivation of HBV (HBsAg and HBeAg positivewith a HBV-DNA level of 3120 pg/mL). After 7 months, shedeveloped pancreatitis which resolved following cessation oflamivudine. Treatment resumed with entecavir. Three monthslater she remained asymptomatic with a declining HBV-DNAlevel and a slight improvement in her liver function.
Author comment: "Rituximab induces profound anddurable B-cell depletion. This may account for the increasingincidence of HBV reactivation in HBsAg-negative patients."
* It is not specified whether the patients were receiving prednisone orprednisolone as part of R-CHOP
Garcia-Rodriguez MJ, et al. Late reactivation of resolved hepatitis B virusinfection: an increasing complication post rituximab-based regimens treatment?American Journal of Hematology 83: 673-675, No. 8, Aug 2008 -Spain 801117780
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Reactions 6 Sep 2008 No. 12180114-9954/10/1218-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
