Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
J Immunother Cancer. 2019 Nov 21;7(1):315. doi: 10.1186/s40425-019-0790-y.
Hepatitis B virus (HBV) reactivation is commonly seen in HBsAg-positive hematologic patients undergoing immunosuppressive chemotherapy. Little is known about the risk of HBV reactivation after chimeric antigen receptor T-cell (CAR T) immunotherapy for the treatment of refractory/relapsed malignant B-cell lymphoma.
We report a patient who underwent antiviral prophylaxis for 26 months and who discontinued treatment by herself 1 month after the sequential infusion of two specific, third-generation anti-CD19 and anti-CD22 CAR T cell immunotherapies for refractory/relapsed diffuse large B-cell lymphoma. Remission of the primary disease was achieved after two and half months, but she was admitted with a 7-day history of vomiting, jaundice, itching and dark urine. After excluding other possible causes of acute liver damage, HBV reactivation was suspected. HBV-DNA was 4,497,000 IU/mL at that time. Following the reintroduction of entecavir, a decline in the HBV-DNA copies was observed, but ALT, AST and bilirubin were elevated, and there was no improvement of the clinical conditions. She passed away because of hepatic encephalopathy and multiple organ dysfunction syndrome 40 days after admission.
Our study provides the first report of the severe, early reactivation of an inactive HBsAg carrier after CAR T cell therapy in DLBCL.
ChiCTR-OPN-16008526.
HBV 病毒（HBV）再激活在接受免疫抑制化疗的 HBsAg 阳性血液学患者中很常见。对于接受嵌合抗原受体 T 细胞（CAR T）免疫疗法治疗难治/复发恶性 B 细胞淋巴瘤的患者，HBV 再激活的风险知之甚少。
我们报告了一例患者，该患者接受了 26 个月的抗病毒预防治疗，并在接受两种特定的第三代抗 CD19 和抗 CD22 CAR T 细胞免疫疗法序贯输注治疗难治/复发弥漫性大 B 细胞淋巴瘤后 1 个月自行停止治疗。在两个月半后达到了主要疾病的缓解，但她因呕吐、黄疸、瘙痒和黑尿 7 天而入院。在排除其他可能导致急性肝损伤的原因后，怀疑 HBV 再激活。当时 HBV-DNA 为 4497000 IU/ml。在重新引入恩替卡韦后，HBV-DNA 拷贝数下降，但 ALT、AST 和胆红素升高，临床状况没有改善。入院后 40 天，她因肝性脑病和多器官功能障碍综合征去世。
我们的研究首次报道了在 DLBCL 中，CAR T 细胞治疗后，HBsAg 携带者的 HBV 发生严重、早期再激活。
ChiCTR-OPN-16008526。
