title: B-cell lymphoma developing de novo hepatitis B after salvage therapies including rituximab through seroconversion of surface antibody.
abstract: The patient was a 73-year-old woman. At 63 years of age, she had developed follicular lymphoma that showed a complete response to R-CHOP therapy. Over the subsequent 8 years, she experienced 4 relapses and was administered rituximab monotherapy once, combined rituximab-fludarabine therapy twice, and CHASE-R therapy once, achieving a complete response each time. Before her first therapy, hepatitis B virus (HBV) surface antigen was negative, while hepatitis B surface antibody (anti-HBs) and hepatitis B core antibody were not measured. Later, before her second salvage therapy, anti-HBs was negative, but then changed to positive before her third salvage therapy. HBV-DNA was negative before CHASE-R therapy. At 16 months after completing the CHASE-R therapy, she developed hepatitis and HBV-DNA had changed to positive. Hepatitis did not become fulminant and entecavir administration was effective. It was surmised that HBV had resolved, but she became negative for anti-HBs following the rituximab-containing chemotherapy. Therefore, this is a rare case in which de novo hepatitis developed after the final chemotherapy. The prognosis of patients with de novo hepatitis accompanying treatment of B-cell lymphoma is poor. In those who undergo lymphoma salvage therapy, the risk for and clinical course of HBV reactivation might differ from those of treatment-naïve patients.
authors.affiliation: Department of Internal Medicine, Kin-ikyo Chuo Hospital.
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Ishihara
authors.forename: Michiyo
authors.initials: M
authors.lastname: Kanagawa
authors.forename: Junichi
authors.initials: J
authors.lastname: Koyama
authors.forename: Kiminori
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hirayama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Terui
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006509:Hepatitis B / Q000209:etiology* / Q000276:immunology* / Q000821:virology; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology / Q000502:physiology; D006801:Humans; D016393:Lymphoma, B-Cell / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D011241:Prednisone / Q000008:administration & dosage; D012008:Recurrence; D012074:Remission Induction; D012306:Risk; D000069283:Rituximab; D016879:Salvage Therapy; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014750:Vincristine / Q000008:administration & dosage; D014775:Virus Activation
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; C571759:R-CHOP protocol; D003561:Cytarabine; D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine; D011241:Prednisone