title: Risk of hepatitis B reactivation and the role of novel agents and stem-cell transplantation in multiple myeloma patients with hepatitis B virus (HBV) infection.
abstract: BACKGROUND
  The purpose of the study is to analyse the prevalence of hepatitis B virus (HBV) infection and its incidence of reactivation among multiple myeloma (MM) patients treated in the era of novel therapy in an endemic Asian setting.
  
  
  METHODS
  From 2000 to 2008, 273 patients with newly diagnosed MM were screened for the presence of hepatitis B virus surface antigen and HBV core antibody. HBV-infected patients were prospectively followed for reactivation with serial monitoring of serum alanine transferase and HBV DNA load. The patterns of HBV reactivation in relation to treatment received, exposure to high-dose therapy with autologous stem-cell transplantation (HDT/ASCT) and novel agents were studied.
  
  
  RESULTS
  The prevalence of HBV infection was 5.5%. Three cases of HBV reactivation despite lamivudine prophylaxis were reported. Two patients reactivated 3-5 months after HDT/ASCT while receiving thalidomide maintenance and one reactivated 3 years after HDT/ASCT and shortly after bortezomib salvage therapy. Emergence of a mutant HBV strain was documented in one patient.
  
  
  CONCLUSIONS
  Use of prophylaxis may reduce but will not preclude HBV reactivation. Highest risk occurs during immune reconstitution phase of HDT/ASCT. The role of immunomodulatory agents in HBV reactivation needs to be further elucidated. Separate HBV prophylaxis and surveillance guidelines ought to be developed for patients with MM.
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore, Republic of Singapore.
authors.forename: D H T
authors.initials: DH
authors.lastname: Mya
authors.forename: S T
authors.initials: ST
authors.lastname: Han
authors.forename: Y C
authors.initials: YC
authors.lastname: Linn
authors.forename: W Y K
authors.initials: WY
authors.lastname: Hwang
authors.forename: Y T
authors.initials: YT
authors.lastname: Goh
authors.forename: D C L
authors.initials: DC
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D001897:Boronic Acids / Q000009:adverse effects; D000069286:Bortezomib; D015897:Comorbidity; D019353:Endemic Diseases; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects*; D015994:Incidence; D019259:Lamivudine / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000453:epidemiology* / Q000628:therapy*; D015995:Prevalence; D011446:Prospective Studies; D011719:Pyrazines / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014182:Transplantation, Autologous; D014775:Virus Activation / Q000187:drug effects / Q000276:immunology*
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D001897:Boronic Acids; D007155:Immunologic Factors; D011719:Pyrazines; D019259:Lamivudine; D000069286:Bortezomib