Fulminant hepatic failure due to chemotherapy-induced hepatitis B reactivation: role of rituximab.
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.
Stange
M A
MA
Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover, Germany.
Tutarel
O
O
Pischke
S
S
Schneider
A
A
Strassburg
C P
CP
Becker
T
T
Barg-Hock
H
H
Bastürk
M
M
Wursthorn
K
K
Cornberg
M
M
Ott
M
M
Greten
T F
TF
Manns
M P
MP
Wedemeyer
H
H
D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D017690:Cell Transplantation; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D017809:Fatal Outcome; D006509:Hepatitis B / Q000139:chemically induced* / Q000628:therapy; D022781:Hepatocytes / Q000637:transplantation; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects*; D017093:Liver Failure / Q000139:chemically induced* / Q000628:therapy; D016031:Liver Transplantation; D016393:Lymphoma, B-Cell / Q000188:drug therapy*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab; D013274:Stomach Neoplasms / Q000188:drug therapy*; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use; D014775:Virus Activation / Q000187:drug effects*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000998:Antiviral Agents; D007155:Immunologic Factors; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone