Abstract
Reactivation of hepatitis B virus (HBV) is a well-known complication in patients with hematological malignancies during or after cytotoxic chemotherapy. If the initiation of antiviral therapy is delayed in patients with HBV reactivation, these patients can develop severe hepatitis and may die of fulminant hepatitis. The preventive strategy for HBV reactivation in patients with malignant lymphoma has already been established based on some prospective studies. As there was an increased number of novel agents being approved for the treatment of multiple myeloma (MM), the number of reported cases of HBV reactivation among MM patients has gradually increased. We conducted a Japanese nationwide retrospective study and revealed that HBV reactivation in MM patients is not rare and that autologous stem cell transplantation is a significant risk factor. In this study, around 20% of all patients with HBV reactivation developed HBV reactivation after 2 years from the initiation of therapy, unlike malignant lymphoma. This might be due to the fact that almost all of the patients received chemotherapy for a long duration. Therefore, a new strategy for the prevention of HBV reactivation in MM patients is required.
Highlights
An estimated 2 billion people worldwide have evidence of either current or past hepatitis B virus (HBV) infection, including 257 million people with chronic HBV infection (HBV carriers), who are defined as testing positive for hepatitis B surface antigen (HBsAg) [1,2]
HBV reactivation is caused by regrowth of HBV in the body, and it can induce severe flares of hepatitis, which can in turn lead to fatal fulminant hepatitis [4]
HBV reactivation is known to occur in patients with resolved HBV infection, with resolution being defined as testing negative for HBsAg but positive for antibodies against hepatitis B core antigen and/or antibodies against hepatitis B surface antigen [6]
Summary
An estimated 2 billion people worldwide have evidence of either current or past hepatitis B virus (HBV) infection, including 257 million people with chronic HBV infection (HBV carriers), who are defined as testing positive for hepatitis B surface antigen (HBsAg) [1,2]. HBV reactivation is known to occur in patients with resolved HBV infection, with resolution being defined as testing negative for HBsAg but positive for antibodies against hepatitis B core antigen (anti-HBc) and/or antibodies against hepatitis B surface antigen (anti-HBs) [6]. There have been subsequent reports of HBV reactivation in cases of immune-chemotherapy or immunosuppressive therapy for other malignancies or autoimmune disorders [7,8,9,10]. These patients included HBV carriers but Cancers 2019, 11, 1819; doi:10.3390/cancers11111819 www.mdpi.com/journal/cancers. HBV reactivation-related hepatitis and liver failure have been recognized as an important complication of cancer chemotherapy and immunosuppressive therapy.
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