Severe hepatitis related to chemotherapy in hepatitis B virus carriers with hematologic malignancies. Survey in Japan, 1987-1991.
BACKGROUND
Hepatitis B (HB) virus (HBV) infection is often reactivated, leading to severe hepatitis and death. Because the actual incidence of such complications is unknown, the authors surveyed hospitals to record the incidence of these complications and to identify clinical parameters that would possibly predict the development of hepatic complications.


METHODS
First, 250 hospitals, belonging to the Japanese Society of Clinical Hematology, were surveyed for hematologic patients with chronic hepatitis or those with asymptomatic hepatitis virus infection in whom severe hepatitis related to chemotherapy occurred between 1987 and 1991. Second, 117 hospitals that responded to the first questionnaire were surveyed for HBV carriers without severe hepatitis who were prescribed chemotherapy.


RESULTS
One-half the number of patients with severe hepatitis were HBV carriers. The incidence of severe hepatitis (52.7%) and the mortality rate (23.6%) were extremely high in HBV carriers. The incidence of severe hepatitis was significantly higher in patients with chronic hepatitis or those receiving corticosteroids (P < 0.05). The mortality rate was significantly lower in patients who were positive for hepatitis Be antigen (HBeAg) and negative for the antibody to HBeAg (anti-HBe), compared with findings in other patients (P < 0.05).


CONCLUSIONS
HBV infection is a major causal agent for severe hepatitis related to chemotherapy in Japanese individuals. Chemotherapy, including corticosteroids, to treat hematologic malignancies should be considered risky in HBV carriers, especially those with chronic hepatitis or serologies negative for HBeAg and positive for anti-HBe.
Nakamura
Y
Y
Fourth Department of Internal Medicine, University of Tokyo, School of Medicine, Japan.
Motokura
T
T
Fujita
A
A
Yamashita
T
T
Ogata
E
E
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002353:Carrier State; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D003625:Data Collection; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy*; D006509:Hepatitis B / Q000150:complications*; D006761:Hospitals; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged
D000970:Antineoplastic Agents