title: Glucocorticoids and antivirals for HBV reactivation in onco-hematologic patients.
abstract: Patients with inactive or occult hepatitis B virus infection and onco-hematological malignancies are at risk of hepatitis flare, hepatic failure and death due to chemotherapy-mediated reactivation. Nucleot(s)ide analogues can reduce reactivation risks and/or hepatitis. However, immuno-mediated phenomena combine to determine liver damage and clinical outcome. We describe in this report two patients with onco-hematological malignancies and hepatitis B reactivation after chemotherapy in whom glucocorticoids were added to nucleot(s)ide. Antiviral therapy was effective on replication, while glucocorticoids managed hyperergic response. One patient without underlying liver disease survived, while the second died and the autopsy demonstrated cirrhosis undetected before death. This clinical trial suggests that in patients with onco-hematological malignancies and altered liver function tests in spite of effective antiviral response, glucocorticoids could control the effects of immune response. However prognosis and survival are related to the underlying liver status.
authors.affiliation: Gastroenterology and Hepatology, San Giovanni Battista Hospital, Turin, Italy. Corso Bramante 88, 10125 Torino, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Marzano
authors.forename: Andrea
authors.initials: A
authors.lastname: Marengo
authors.forename: Michela
authors.initials: M
authors.lastname: di Fonzo
authors.forename: Paola
authors.initials: P
authors.lastname: Begini
authors.forename: Antonella
authors.initials: A
authors.lastname: Ferrari
authors.forename: Bruno
authors.initials: B
authors.lastname: Monarca
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Delle Fave
authors.forename: Massimo
authors.initials: M
authors.lastname: Marignani