Abstract
In the absence of prophylaxis, the reactivation of hepatitis B in oncology patients who are hepatitis B carriers is a well-known and often fatal complication of chemotherapy. The current recommendations in Canada and the USA are that patients who are positive for hepatitis B surface antigen (HBsAg) receive antiviral prophylaxis prior to chemotherapy. We report a 67-year-old man with B-cell lymphoma who developed hepatitis B reactivation following chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisone and rituximab. Pre-chemotherapy, the patient was negative for HBsAg, positive for hepatitis B core antibody (anti-HBc) and weakly positive for hepatitis B surface antibody. Despite treatment with lamivudine, the patient died of fulminant hepatic failure. Our experience indicates that patients who are negative for HBsAg but positive for anti-HBc are still at risk for reactivation of latent hepatitis B during and after chemotherapy and may be considered for prophylaxis.
MeSH terms
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Aged
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Anti-HIV Agents / therapeutic use
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Antibodies, Monoclonal / administration & dosage
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Antibodies, Monoclonal, Murine-Derived
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
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Cyclophosphamide / administration & dosage
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Doxorubicin / administration & dosage
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Fatal Outcome
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Hepatitis B / drug therapy
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Hepatitis B / prevention & control*
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Hepatitis B Antibodies / immunology
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Hepatitis B Antibodies / metabolism*
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Hepatitis B Core Antigens / immunology
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Hepatitis B Surface Antigens / metabolism*
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Hepatitis B virus / drug effects
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Hepatitis B virus / growth & development*
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Humans
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Lamivudine / therapeutic use
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Liver Failure / drug therapy
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Liver Failure / etiology
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Lymphoma, B-Cell / drug therapy
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Lymphoma, B-Cell / pathology
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Lymphoma, B-Cell / virology*
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Male
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Prednisone / administration & dosage
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Rituximab
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Vincristine / administration & dosage
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Virus Activation / drug effects*
Substances
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Anti-HIV Agents
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Murine-Derived
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Hepatitis B Antibodies
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Hepatitis B Core Antigens
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Hepatitis B Surface Antigens
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Lamivudine
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Rituximab
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Vincristine
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Doxorubicin
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Cyclophosphamide
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Prednisone