Faggioli P, De Paschale M, Tocci A, Luoni M, Fava S, De Paoli A, Tosi A, Cassi E
Sezione di Emato/Oncologia, Ospedale di Legnano, Italy.
Haematologica. 1997 Jan-Feb;82(1):38-42.
Hepatic toxicity directly related to the drugs administered in cyclic chemotherapy (CT), although sometimes serious, does not limit the treatment of non-Hodgkin's lymphoma (NHL). Nevertheless, reports of reactivation of viral hepatitis in NHL patients with B virus (HBV) infection are becoming more frequent. The recent observation of two cases of severe liver toxicity directly correlated to CT and a case of fatal hepatic failure due to HBV replication prompted us to evaluate the hepatic toxicity of CT in 98 consecutive B-cell NHL patients treated with relatively homogeneous cyclic CT.
Acute hepatic toxicity was retrospectively evaluated in 98 consecutive B-cell NHL patients who received induction CT. HBV and HCV markers were checked at presentation. All patients were tested for ALT and bilirubin before every CT course, while tests for HBV-DNA and/or for HCV-RNA were performed with PCR only when hepatitis occurred.
At presentation 22 patients (22.4%) were positive for HBsAg, and 11 (15.9%) were positive for anti-HCV. Acute hepatitis developed in 12 (12.2%) NHL patients: 8 (out of 22) in HBsAg-positive and anti-HCV-negative patients, 3 (out of 76) in HBsAg-negative patients, and 1 (out of 11) in anti-HCV-positive patients. Hepatitis was attributed to reactivation of chronic B hepatitis in 3 patients and to drug toxicity in 3 others; hepatitis was undefined in 6 cases.
Drug-related liver toxicity is not a rare occurrence in NHL patients. Reactivation of HBV replication is responsible for a relevant number of the hepatitis cases observed. We did not detect acute hepatitis due to the reactivation of HCV replication (in chronic C hepatitis carriers).
在循环化疗（CT）中，与所使用药物直接相关的肝毒性虽然有时较为严重，但并不限制非霍奇金淋巴瘤（NHL）的治疗。然而，B病毒（HBV）感染的NHL患者中病毒性肝炎再激活的报道日益增多。最近观察到两例与CT直接相关的严重肝毒性病例以及一例因HBV复制导致的致命肝衰竭病例，促使我们对98例接受相对统一循环CT治疗的连续B细胞NHL患者的CT肝毒性进行评估。
对98例接受诱导CT的连续B细胞NHL患者的急性肝毒性进行回顾性评估。就诊时检查HBV和HCV标志物。所有患者在每个CT疗程前检测ALT和胆红素，仅在发生肝炎时用PCR检测HBV-DNA和/或HCV-RNA。
就诊时22例患者（22.4%）HBsAg阳性，11例患者（15.9%）抗-HCV阳性。12例（12.2%）NHL患者发生急性肝炎：HBsAg阳性且抗-HCV阴性患者中有8例（共22例），HBsAg阴性患者中有3例（共76例），抗-HCV阳性患者中有1例（共11例）。3例肝炎归因于慢性B型肝炎再激活，另外3例归因于药物毒性；6例肝炎病因不明。
药物相关的肝毒性在NHL患者中并不罕见。HBV复制再激活是所观察到的相当一部分肝炎病例的病因。我们未检测到因HCV复制再激活（慢性丙型肝炎携带者中）导致的急性肝炎。
