Motomura Yotaro, Yoshifuji Kota, Tanaka Keisuke, Sakashita Chizuko, Umezawa Yoshihiro, Nagao Toshikage, Nitta Sayuri, Asahina Yasuhiro, Mori Takehiko, Yamamoto Masahide
Department of Hematology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
J Clin Exp Hematop. 2024 Dec 25;64(4):313-317. doi: 10.3960/jslrt.24042. Epub 2024 Nov 28.
Reactivation of hepatitis viruses during chemotherapy can be problematic in the treatment of malignant lymphomas. However, studies on reactivation of chronic hepatitis C virus (HCV) infection are limited. A 43-year-old woman presented with generalized lymphadenopathy and multiple liver tumors, and she was diagnosed with follicular lymphoma (grade 3a; clinical stage IV). Chronic HCV infection was clinically diagnosed. Immunochemotherapy (ICT), including bendamustine and obinutuzumab, was initiated with close liver function monitoring without specific treatment for hepatitis C. However, liver dysfunction worsened 17 days after ICT initiation, and ICT was interrupted. HCV-RNA and transaminase levels continued to elevate. Liver biopsy results confirmed acute exacerbation of chronic hepatitis C. Direct active antiviral (DAA) therapy was started and effective. She has maintained a sustained virologic response since DAA therapy ended. With regard to lymphoma, complete metabolic response was maintained for 4 years without additional treatment. Physicians should be aware of HCV reactivation with hepatitis flare after ICT for lymphoma and consider the indication and timing of DAA therapy for hepatitis C in this setting.
化疗期间肝炎病毒的重新激活在恶性淋巴瘤的治疗中可能会成为问题。然而，关于慢性丙型肝炎病毒（HCV）感染重新激活的研究有限。一名43岁女性出现全身淋巴结肿大和多发肝肿瘤，被诊断为滤泡性淋巴瘤（3a级；临床IV期）。临床诊断为慢性HCV感染。开始采用包括苯达莫司汀和奥妥珠单抗的免疫化疗（ICT），同时密切监测肝功能，未对丙型肝炎进行特殊治疗。然而，ICT开始后17天肝功能恶化，ICT中断。HCV-RNA和转氨酶水平持续升高。肝活检结果证实为慢性丙型肝炎急性加重。开始直接抗病毒（DAA）治疗且有效。自DAA治疗结束以来，她一直保持持续病毒学应答。关于淋巴瘤，在未进行额外治疗的情况下，完全代谢缓解维持了4年。医生应意识到淋巴瘤患者接受ICT后HCV重新激活并伴有肝炎发作，并在此情况下考虑DAA治疗丙型肝炎的适应证和时机。
