Abstract
Hepatitis B virus reactivation during immunosuppressive therapies can lead to liver failure with very limited treatment options available. We report here on two cases of severe hepatitis B reactivation during chemotherapy including rituximab for B cell lymphoma which were treated with liver or liver-cell transplantation. Liver function was normal and HBV infection was unknown in both patients before chemotherapy was started. Impaired liver function became apparent after 4 and 6 courses of chemotherapy, respectively, and both patients experienced fulminant hepatic failure despite antiviral treatment with lamivudine or entecavir. Patient A underwent liver transplantation after documentation of complete remission of the lymphoma and survived without any evidence for hepatitis B recurrence. Patient B received 4 courses of hepatocyte transplantation but did not survive. These cases underline the importance of anti-HBc screening in patients receiving immunosuppressive treatments in particular when rituximab is given. Pre-emptive antiviral treatments should be administered since delayed antiviral treatment is frequently unable to prevent liver failure.
MeSH terms
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Antibodies, Monoclonal / administration & dosage
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Antibodies, Monoclonal / adverse effects*
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Antibodies, Monoclonal, Murine-Derived
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Antineoplastic Combined Chemotherapy Protocols / adverse effects*
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Antiviral Agents / therapeutic use
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Cell Transplantation
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Cyclophosphamide / adverse effects
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Cyclophosphamide / therapeutic use
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Doxorubicin / adverse effects
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Doxorubicin / therapeutic use
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Fatal Outcome
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Hepatitis B / chemically induced*
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Hepatitis B / therapy
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Hepatocytes / transplantation
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Humans
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Immunologic Factors / administration & dosage
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Immunologic Factors / adverse effects*
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Liver Failure / chemically induced*
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Liver Failure / therapy
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Liver Transplantation
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Lymphoma, B-Cell / drug therapy*
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Lymphoma, B-Cell, Marginal Zone / drug therapy*
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Male
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Middle Aged
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Prednisone / adverse effects
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Prednisone / therapeutic use
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Rituximab
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Stomach Neoplasms / drug therapy*
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Vincristine / adverse effects
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Vincristine / therapeutic use
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Virus Activation / drug effects*
Substances
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Murine-Derived
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Antiviral Agents
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Immunologic Factors
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Rituximab
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Vincristine
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Doxorubicin
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Cyclophosphamide
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Prednisone