Ishihara Toshimichi, Kanagawa Michiyo, Koyama Junichi, Hasegawa Kiminori, Suzuki Takashi, Hirayama Yasuo, Terui Takeshi
Department of Internal Medicine, Kin-ikyo Chuo Hospital.
Rinsho Ketsueki. 2014 Nov;55(11):2283-7.
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.
该患者为一名73岁女性。63岁时，她被诊断出患有滤泡性淋巴瘤，对R-CHOP疗法显示出完全缓解。在随后的8年里，她经历了4次复发，接受过1次利妥昔单抗单药治疗、2次利妥昔单抗-氟达拉滨联合治疗以及1次CHASE-R治疗，每次均实现完全缓解。首次治疗前，乙肝病毒（HBV）表面抗原呈阴性，未检测乙肝表面抗体（抗-HBs）和乙肝核心抗体。后来，在第二次挽救治疗前，抗-HBs呈阴性，但在第三次挽救治疗前转为阳性。CHASE-R治疗前HBV-DNA呈阴性。在完成CHASE-R治疗16个月后，她患上肝炎，HBV-DNA转为阳性。肝炎未发展为暴发性，恩替卡韦治疗有效。据推测HBV已清除，但在接受含利妥昔单抗的化疗后，她的抗-HBs转为阴性。因此，这是一例在最后一次化疗后出现新发肝炎的罕见病例。B细胞淋巴瘤治疗后新发肝炎患者的预后较差。在接受淋巴瘤挽救治疗的患者中，HBV再激活的风险和临床过程可能与初治患者不同。
