Antineoplastics
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Reactions 1320 - 25 Sep 2010 S Antineoplastics Hepatitis B reactivation: case report A 57-year-old woman experienced a hepatitis B virus (HBV) reactivation after intensive treatment with antineoplastics for acute lymphoblastic leukaemia. The woman initially received phase I induction chemotherapy consisting of vincristine 1.5 mg/m 2 /day (max 2 mg) and daunorubicin 25 mg/m 2 /day on days 1, 8, 15 and 22, asparaginase 5 000 U/m 2 /day on days 1-14, prednisolone 60 mg/m 2 /day on days 1-28 [routes not stated] and phase II induction therapy with intrathecal methotrexate 12mg on days 1, 8, 15 and 22, cyclophosphamide 650 mg/m 2 /day on days 29, 43 and 57, cytarabine 75 mg/m 2 /day on days 31-34, 38-41, 45-48 and 52-57 and mercaptopurine 60 mg/m 2 /day on days 1-28 [routes not stated]. She then received salvage chemotherapy consisting of mitoxantrone 12 mg/m 2 /day on days 1-3, cytarabine 500 mg/m 2 /day on days 1-3 and 8-10, and etoposide 200 mg/m 2 /day on days 8-10 [routes not stated]. Seven months after her last chemotherapy dose, she presented with signs of acute hepatitis. On admission, her liver enzymes were elevated and she had a positive hepatitis B surface antigen (HBsAg) result. The woman’s liver enzyme levels gradually decreased with 1 year. After 1 year, her HBV-DNA test was negative. Her leukaemia relapsed and she received lamivudine, due to a still positive HBsAg result, in addition to chemotherapy with fludarabine, cytarabine and idarubicin; her anti-HBs antibodies were negative during follow-up and her liver enzymes remained normal. However, she later died of a probable bacterial infection during an episode of febrile neutropenia. Author comment: "[O]ur patient developed reverse seroconversion while she was receiving immunosuppressive therapy." Ozaras R, et al. Acute hepatitis B despite a previous high titer of anti-HBs. Hepatology International 4: 530-532, No. 2, Jun 2010. Available from: URL: http:/ /dx.doi.org/10.1007/s12072-010-9177-3 - Turkey 803039652 1 Reactions 25 Sep 2010 No. 1320 0114-9954/10/1320-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1320 - 25 Sep 2010
SAntineoplastics
Hepatitis B reactivation: case reportA 57-year-old woman experienced a hepatitis B virus
(HBV) reactivation after intensive treatment withantineoplastics for acute lymphoblastic leukaemia.
The woman initially received phase I inductionchemotherapy consisting of vincristine 1.5 mg/m2/day (max2 mg) and daunorubicin 25 mg/m2/day on days 1, 8, 15 and22, asparaginase 5 000 U/m2/day on days 1-14,prednisolone 60 mg/m2/day on days 1-28 [routes notstated] and phase II induction therapy with intrathecalmethotrexate 12mg on days 1, 8, 15 and 22,cyclophosphamide 650 mg/m2/day on days 29, 43 and 57,cytarabine 75 mg/m2/day on days 31-34, 38-41, 45-48 and52-57 and mercaptopurine 60 mg/m2/day on days 1-28[routes not stated]. She then received salvagechemotherapy consisting of mitoxantrone 12 mg/m2/dayon days 1-3, cytarabine 500 mg/m2/day on days 1-3 and8-10, and etoposide 200 mg/m2/day on days 8-10 [routesnot stated]. Seven months after her last chemotherapydose, she presented with signs of acute hepatitis. Onadmission, her liver enzymes were elevated and she had apositive hepatitis B surface antigen (HBsAg) result.
The woman’s liver enzyme levels gradually decreasedwith 1 year. After 1 year, her HBV-DNA test was negative.Her leukaemia relapsed and she received lamivudine, dueto a still positive HBsAg result, in addition to chemotherapywith fludarabine, cytarabine and idarubicin; her anti-HBsantibodies were negative during follow-up and her liverenzymes remained normal. However, she later died of aprobable bacterial infection during an episode of febrileneutropenia.
Author comment: "[O]ur patient developed reverseseroconversion while she was receiving immunosuppressivetherapy."Ozaras R, et al. Acute hepatitis B despite a previous high titer of anti-HBs.Hepatology International 4: 530-532, No. 2, Jun 2010. Available from: URL: http://dx.doi.org/10.1007/s12072-010-9177-3 - Turkey 803039652
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Reactions 25 Sep 2010 No. 13200114-9954/10/1320-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
