接受含来那度胺和/或硼替佐米方案治疗的多发性骨髓瘤患者中乙肝再激活率及转归情况
Hepatitis B Reactivation Rate and Fate Among Multiple Myeloma Patients Receiving Regimens Containing Lenalidomide and/or Bortezomib.
作者信息
Ataca Atilla Pınar, Yalçıner Merih, Atilla Erden, İdilman Ramazan, Beksaç Meral
机构信息
Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
Ankara University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
出版信息
Turk J Haematol. 2019 Nov 18;36(4):266-273. doi: 10.4274/tjh.galenos.2019.2019.0103. Epub 2019 Aug 1.
OBJECTIVE
Reactivation of the hepatitis B virus (HBV) refers to an increase in HBV replication in a patient with inactive or resolved HBV. In this retrospective study, our aim is to present and compare HBV reactivation in multiple myeloma (MM) patients who received lenalidomide and/or bortezomib at any time during treatment, evaluate the factors associated with reactivation, and demonstrate the outcome of patients.
MATERIALS AND METHODS
We evaluated 178 MM patients who received lenalidomide (n=102) and/or bortezomib (n=174) during their treatment schedules. The HBsAg, anti-HBc, anti-HBs, HBeAg, and anti-HBe were detected by chemiluminescence by ARCHITECT lab analyzers using commercially available kits (Abbott, USA). HBV-DNA titers were determined by quantitative PCR. The results were evaluated by IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA).
RESULTS
HBV reactivation was diagnosed in 6 patients (3%) after bortezomib and in 8 patients (8%) after bortezomib and lenalidomide. Three of the patients in each group had HBsAg+, HBeAg+, AntiHBeAg-, AntiHBc-, and AntiHBS+ status, whereas 5 patients in the bortezomib- and lenalidomide-treated group and 3 patients in the bortezomib-treated group had HBsAg-, HBeAg-, AntiHBeAg-, AntiHBc-, and AntiHBS+ status prior to treatment. There were no statistical differences observed between HBV reactivation in the bortezomib-treated or bortezomib- and lenalidomide-treated groups in terms of age at diagnosis, sex, International Staging System subtype, frequency of extramedullary disease, dialysis requirement, or receiving of autologous stem cell transplantation. In patients who received antiviral prophylaxis, a higher incidence of HBV reactivation was detected in HBsAg-positive patients compared to HBsAg-negative patients (4/4, 100% vs. 2/7, 29%; p=0.045). The 3-year and 5-year overall survival rates were similar in patients with or without HBV reactivation (83% vs. 84%, 73% vs. 74%, p=0.84).
CONCLUSION
Close follow-up is recommended for not only HBsAg-positive but also HBsAg-negative patients.
目的
乙型肝炎病毒（HBV）再激活是指在HBV感染已缓解或静止的患者中，HBV复制增加。在这项回顾性研究中，我们旨在呈现并比较在治疗期间任何时间接受来那度胺和/或硼替佐米的多发性骨髓瘤（MM）患者中的HBV再激活情况，评估与再激活相关的因素，并展示患者的预后。
材料与方法
我们评估了178例在治疗期间接受过来那度胺（n = 102）和/或硼替佐米（n = 174）的MM患者。使用美国雅培公司的商业化试剂盒，通过ARCHITECT实验室分析仪的化学发光法检测HBsAg、抗-HBc、抗-HBs、HBeAg和抗-HBe。通过定量PCR测定HBV-DNA滴度。结果采用IBM SPSS Statistics for Windows 20.0版软件（美国纽约州阿蒙克市IBM公司）进行评估。
结果
硼替佐米治疗后有6例患者（3%）被诊断为HBV再激活，硼替佐米联合来那度胺治疗后有8例患者（8%）被诊断为HBV再激活。每组中有3例患者的HBsAg、HBeAg、抗-HBeAg、抗-HBc和抗-HBs呈阳性，而在硼替佐米联合来那度胺治疗组中有5例患者以及硼替佐米治疗组中有3例患者在治疗前的HBsAg、HBeAg、抗-HBeAg、抗-HBc和抗-HBs呈阴性。在硼替佐米治疗组或硼替佐米联合来那度胺治疗组的HBV再激活患者之间，在诊断时的年龄、性别、国际分期系统亚型、髓外疾病发生率、透析需求或自体干细胞移植接受情况方面均未观察到统计学差异。在接受抗病毒预防的患者中，HBsAg阳性患者的HBV再激活发生率高于HBsAg阴性患者（4/4，100%对2/7，29%；p = 0.045）。有或无HBV再激活患者的3年和5年总生存率相似（83%对84%，73%对74%，p = 0.84）。
结论
建议对HBsAg阳性和阴性患者均进行密切随访。
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