Hepatitis B virus reactivation in patients with multiple myeloma receiving bortezomib-containing regimens followed by autologous stem cell transplant

Abstract

To investigate hepatitis B virus (HBV) reactivation and survival in patients with multiple myeloma (MM) receiving bortezomib-containing regimens, we analyzed 139 patients with MM receiving bortezomib-containing regimens in our hospital. Twenty-seven/139 patients were hepatitis B surface antigen positive (HBsAg+) with nine having DNA levels > 500 IU/mL, including four > 1000 IU/mL. All but five HBsAg+ patients were treated with lamivudine or entecavir before chemotherapy until at least 6 months after chemotherapy or autologous stem cell transplant (ASCT). HBV reactivation occurred in six HBsAg+ patients and two HBsAg- patients, including six who received ASCT. Overall survival and progression-free survival of HBsAg- patients were significantly longer than for HBsAg+ patients (both p < 0.01). From these results, we confirmed that the incidence of HBV reactivation was notable in patients with MM receiving bortezomib-containing regimens, especially those who underwent ASCT. HBsAg+ patients with MM had a poorer prognosis than HBsAg- patients. Prophylactic treatment should be prescribed to all patients with HBsAg+ MM for a minimum duration of 12 months.

Bortezomib followed by autologous stem cell transplant for patients with hepatitis B positive multiple myeloma: a cautionary note

“…The additive immunosuppressive effect of bortezomib and autologous SCT in causing hepatitis B reactivation is an even more important question in the year 2015, since bortezomib-containing regimens in conjunction with autoSCT are now also being used to treat aggressive lymphomas in addition to myeloma. It is therefore urgent that further retrospective studies in other populations be undertaken to confirm the observations of Li et al [1]. Prospective studies are not possible, since the current standard of care for previously exposed patients mandates preventive antiviral treatment, which is highly successful if administered properly.…”

“…Bortezomib and autologous SCT are frequently used together in the treatment of myeloma, particularly during the last decade. In the study reported in this issue of Leukemia and Lymphoma, Li et al [1] suggest that autoSCT is associated with an increased risk of HBV reactivation particularly in patients who have previously received bortezomib-containing regimens.…”

“…Regarding the process of HBV reactivation, many of the immunopathological processes remain unknown. Fortunately, although reactivation can potentially be fatal [1,2], it can be prevented by preemptive antiviral therapy. The optimal duration of such therapy is not known.…”

“…The optimal duration of such therapy is not known. While it has been suggested that a year is sufficient, late reactivation can rarely occur more than 3 years following autoSCT [1].…”

Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure

“…Reactivation of HBV has been reported in patients treated for lymphoma, other haematological malignancies and in the setting of haematopoetic stem cell transplant [14,[19][20][21][22] . The prevalence of CHB in patients with lymphoma has been reported as high as 26% [15] .…”