Fatal reactivation of hepatitis B post-chemotherapy for lymphoma in a hepatitis B surface antigen-negative, hepatitis B core antibody-positive patient: potential implications for future prophylaxis recommendations

Leuk Lymphoma. 2005 Jul;46(7):1085-9. doi: 10.1080/10428190500062932.

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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-HIV Agents / therapeutic use
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Fatal Outcome
  • Hepatitis B / drug therapy
  • Hepatitis B / prevention & control*
  • Hepatitis B Antibodies / immunology
  • Hepatitis B Antibodies / metabolism*
  • Hepatitis B Core Antigens / immunology
  • Hepatitis B Surface Antigens / metabolism*
  • Hepatitis B virus / drug effects
  • Hepatitis B virus / growth & development*
  • Humans
  • Lamivudine / therapeutic use
  • Liver Failure / drug therapy
  • Liver Failure / etiology
  • Lymphoma, B-Cell / drug therapy
  • Lymphoma, B-Cell / pathology
  • Lymphoma, B-Cell / virology*
  • Male
  • Prednisone / administration & dosage
  • Rituximab
  • Vincristine / administration & dosage
  • Virus Activation / drug effects*

Substances

  • Anti-HIV Agents
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Hepatitis B Surface Antigens
  • Lamivudine
  • Rituximab
  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone