Mimura Naoya, Tsujimura Hideki, Ise Mikiko, Sakai Chikara, Kojima Hiroshige, Fukai Kenichi, Yokosuka Osamu, Takagi Toshiyuki, Kumagai Kyoya
Division of Hematology-Oncology, Chiba Cancer Center.
Rinsho Ketsueki. 2009 Dec;50(12):1715-9.
Here we report three cases of hepatitis B virus (HBV) reactivation after cessation of preemptive lamivudine therapy in B-cell lymphoma patients treated with rituximab plus CHOP (R-CHOP). Two patients received eight cycles of R-CHOP, and one received two cycles of R-CHOP followed by two courses of rituximab. As all the patients were HBV surface antigen (HBsAg) positive, lamivudine was administered simultaneously with R-CHOP to prevent virus reactivation. All the patients developed hepatitis due to HBV reactivation 6, 8 and 13 months after completion of chemotherapy, and 4, 2 and 2 months after cessation of lamivudine, respectively. They were treated with either lamivudine or entecavir and all achieved full recovery. When HBV carriers undergo immunosuppressive anticancer treatment, prophylactic antiviral therapy is well recognized as effective. However, the optimal method of prophylaxis has not yet been established. Since the introduction of rituximab, new problems such as delayed HBV reactivation from HBsAg positive patients and de novo hepatitis B from HBsAg negative patients have emerged. Guidelines for prophylactic antiviral therapy in the era of rituximab need to be established.
在此，我们报告了3例接受利妥昔单抗联合CHOP（R-CHOP）治疗的B细胞淋巴瘤患者在停用抢先使用的拉米夫定治疗后发生乙型肝炎病毒（HBV）再激活的病例。2例患者接受了8个周期的R-CHOP治疗，1例接受了2个周期的R-CHOP治疗，随后接受了2个疗程的利妥昔单抗治疗。由于所有患者均为HBV表面抗原（HBsAg）阳性，因此在使用R-CHOP的同时给予拉米夫定以预防病毒再激活。所有患者分别在化疗结束后6、8和13个月以及拉米夫定停用后4、2和2个月因HBV再激活而发生肝炎。他们接受了拉米夫定或恩替卡韦治疗，均完全康复。当HBV携带者接受免疫抑制性抗癌治疗时，预防性抗病毒治疗被公认为是有效的。然而，最佳的预防方法尚未确立。自从利妥昔单抗问世以来，出现了一些新问题，如HBsAg阳性患者的HBV再激活延迟以及HBsAg阴性患者的新发乙型肝炎。需要制定利妥昔单抗时代预防性抗病毒治疗的指南。
