Contributions
Abstract: PB2042
Type: Publication Only
Background
Reactivation of the hepatitis B virus (HBV) is a serious, and in some cases life-threatening, complication that occurs in patients receiving chemotherapy. Conducting target therapy (rituximab) in mono-regime or in combination with polychemotherapy (PCT) is a factor of high risk of reactivation of HBV. Patients with resolved HBV infection who have a hepatitis B surface antigen (HBsAg) in their blood have a HBV reactivity in more then 80%, and fatal liver failure is not unusual for this category of patients.
Aims
In study included 53 patients with malignant lymphomas who had reactivated HBV from 2002 to 2016 during the treatment of lymphoma. Male: female ratio was 1: 1. The age of the patients ranged from 19 to 82 years (median 35 years). Among patients there were 11 with Hodgkin's lymphoma(HL) and 42 non-Hodgkin's lymphoma(NHL) (18 with indolent and 24 with aggressive). Reactivation of HBV in 89% (47) patients developed after 4-6 courses. In 6 patients, the reactivation of HBV developed after the end of PCT for 3 months. In patients who had reactivation HBV the ALT level was from 90 to 600 IU/L, AST - 70 to 560 UD/L, alkaline phosphatase ranged from 120 to 1700 UD/L, GGTP - from 88 to 960 IU/L. The level of HBV DNA was from 1x105 to 1.6x109 copies/ml.
Methods
All patients with HBV reactivation were prescribed antiviral therapy: 37 patients received lamivudine for 100 mg/day and 15 - entecavir for 1 mg/day.
In 70% (37) patients on antiviral therapy, complete remission of HBV was achieved. In 30% (15) patients, the level of enzymes decreased and was not higher than 2xUIN. However, the level of HBV DNA was from 3x103 to 1x105 copies/ml. Antiviral therapy changed to tenofavir 300 mg per day in all 15 patients. Complete remission was achieved in 11 patients.
4 patients (3 with NHL and 1 with HL) had a short period (3-5 month) of decreasing HBV DNA, then HBV DNA began to rise again. The level of HBV DNA was 1x105- 1.4x107copies/ml. The resistance of HBV to the therapy of tenofavir was verify.
Results
3 patients with NHL received the therapy with alpha interferon. The remission was achieved in 2 patients on therapy with tenofavir+interferon. In 1 patient, the level of HBV DNA was 1x102 copies/ml.
In patient with HL and resistant HBV infection developed the relapse of the HL. The patient, according to vital indications, started PCT. After 2 courses of PCT complications with multi-organ disturbances developed and the patient died.
Conclusion
Therapy of reactivation of HBV in patients with lymphomas is very complex. This problem has not been resolved. We surmise new mutant forms of HBV infection. Chemotherapy may leads the mutations in the genome of the hepatitis B virus. Therapy of new identified mutant forms requires the creation of new molecules. At present, when a multiple resistance of virus B occurs to atypical nucleosides, the main drug in the treatment of this hepatitis B is only alpha interferon
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Hepatitis B virus, lymphoma
Abstract: PB2042
Type: Publication Only
Background
Reactivation of the hepatitis B virus (HBV) is a serious, and in some cases life-threatening, complication that occurs in patients receiving chemotherapy. Conducting target therapy (rituximab) in mono-regime or in combination with polychemotherapy (PCT) is a factor of high risk of reactivation of HBV. Patients with resolved HBV infection who have a hepatitis B surface antigen (HBsAg) in their blood have a HBV reactivity in more then 80%, and fatal liver failure is not unusual for this category of patients.
Aims
In study included 53 patients with malignant lymphomas who had reactivated HBV from 2002 to 2016 during the treatment of lymphoma. Male: female ratio was 1: 1. The age of the patients ranged from 19 to 82 years (median 35 years). Among patients there were 11 with Hodgkin's lymphoma(HL) and 42 non-Hodgkin's lymphoma(NHL) (18 with indolent and 24 with aggressive). Reactivation of HBV in 89% (47) patients developed after 4-6 courses. In 6 patients, the reactivation of HBV developed after the end of PCT for 3 months. In patients who had reactivation HBV the ALT level was from 90 to 600 IU/L, AST - 70 to 560 UD/L, alkaline phosphatase ranged from 120 to 1700 UD/L, GGTP - from 88 to 960 IU/L. The level of HBV DNA was from 1x105 to 1.6x109 copies/ml.
Methods
All patients with HBV reactivation were prescribed antiviral therapy: 37 patients received lamivudine for 100 mg/day and 15 - entecavir for 1 mg/day.
In 70% (37) patients on antiviral therapy, complete remission of HBV was achieved. In 30% (15) patients, the level of enzymes decreased and was not higher than 2xUIN. However, the level of HBV DNA was from 3x103 to 1x105 copies/ml. Antiviral therapy changed to tenofavir 300 mg per day in all 15 patients. Complete remission was achieved in 11 patients.
4 patients (3 with NHL and 1 with HL) had a short period (3-5 month) of decreasing HBV DNA, then HBV DNA began to rise again. The level of HBV DNA was 1x105- 1.4x107copies/ml. The resistance of HBV to the therapy of tenofavir was verify.
Results
3 patients with NHL received the therapy with alpha interferon. The remission was achieved in 2 patients on therapy with tenofavir+interferon. In 1 patient, the level of HBV DNA was 1x102 copies/ml.
In patient with HL and resistant HBV infection developed the relapse of the HL. The patient, according to vital indications, started PCT. After 2 courses of PCT complications with multi-organ disturbances developed and the patient died.
Conclusion
Therapy of reactivation of HBV in patients with lymphomas is very complex. This problem has not been resolved. We surmise new mutant forms of HBV infection. Chemotherapy may leads the mutations in the genome of the hepatitis B virus. Therapy of new identified mutant forms requires the creation of new molecules. At present, when a multiple resistance of virus B occurs to atypical nucleosides, the main drug in the treatment of this hepatitis B is only alpha interferon
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Hepatitis B virus, lymphoma