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硼替佐米为主的方案联合抗乙肝病毒药物治疗家族性多发性骨髓瘤患者后乙肝表面抗原清除:一例报告

Clearance of HBsAg in a patient with familial multiple myeloma after a bortezomib-based regimen combined with anti-HBV drug: A case report.

作者信息

Zhang Xuzhao, Liang Yun, Li Xian, Wang Weiqin, Tong Jiefeng, Xu Yang

机构信息

Department of Hematology.

Cancer Institute (Key Laboratory of Cancer Prevention and Intervention, China National Ministry of Education), The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.

出版信息

Medicine (Baltimore). 2020 Oct 2;99(40):e22642. doi: 10.1097/MD.0000000000022642.

Abstract

RATIONALE

Reactivation of hepatitis B virus (HBV) after treatment with bortezomib-based regimens in HBV-positive patients with multiple myeloma (MM) has been reported in the past few years. Nevertheless, there is evidence of inhibition of HBV replication by bortezomib in transgenic mice. However, there is still no clinical evidence that bortezomib inhibits HBV.

PATIENT CONCERNS

A 55-year-old MM patient with a family history of MM, who was also a chronic HBV carrier, achieved HBV clearance after treatment with a bortezomib-based regimen in combination with anti-HBV drugs.

DIAGNOSES

The diagnosis was MM with chronic carrier of HBV.

INTERVENTIONS

He received bortezomib-based regimen for MM as well as entecavir as a prophylaxis to prevent HBV reactivation.

OUTCOMES

This patient achieved HBsAg and HBV-DNA clearance after 2 months and the remission was maintained during the next 2 years. He also achieved complete remission of MM and underwent consolidation therapy with autologous hematopoietic stem cell transplantation.

LESSONS

This is the first case of MM with HBV clearance after receiving a bortezomib-based regimen combined with anti-HBV drug. Research on related mechanisms might provide new suggestions and hope for better management of HBV positive patients with MM and for the treatment of HBV patients.

摘要

理论依据

在过去几年中,已有报告称在接受基于硼替佐米方案治疗的多发性骨髓瘤(MM)乙肝病毒(HBV)阳性患者中出现HBV再激活。然而,有证据表明硼替佐米在转基因小鼠中可抑制HBV复制。但是,仍没有临床证据表明硼替佐米能抑制HBV。

患者情况

一名55岁的MM患者,有MM家族史,也是慢性HBV携带者,在接受基于硼替佐米的方案联合抗HBV药物治疗后实现了HBV清除。

诊断

诊断为MM合并慢性HBV携带者。

干预措施

他接受了基于硼替佐米的MM治疗方案以及恩替卡韦作为预防措施以防止HBV再激活。

结果

该患者在2个月后实现了HBsAg和HBV-DNA清除,并且在接下来的2年中维持了缓解状态。他还实现了MM的完全缓解,并接受了自体造血干细胞移植巩固治疗。

经验教训

这是首例在接受基于硼替佐米的方案联合抗HBV药物治疗后实现HBV清除的MM病例。对相关机制的研究可能为更好地管理HBV阳性MM患者以及治疗HBV患者提供新的建议和希望。

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