Incidence of hepatitis virus infection and severe liver dysfunction in patients receiving chemotherapy for hematologic malignancies

Abstract

Hepatitis virus infection through virus reactivation has a high risk of mortality in patients with hematological malignancies receiving chemotherapy. We examined the incidence of both hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and severe liver dysfunction (alanine aminotransferase >ten times the normal upper limit and total bilirubin >5 mg/dl) during chemotherapy in 268 patients with hematological malignancies. Eight patients (3.0%) were infected with HBV and 22 patients (8.2%) were infected with HCV. One patient (0.4%) was infected with both HBV and HCV. HBV- or HCV-infected patients showed severe liver dysfunction at a significantly higher incidence than non-infected patients (11/31 (35.5%) vs. 0/237 (0%), p<0.0001). Furthermore, the incidence of severe liver dysfunction in HBV-infected patients was significantly higher than in HCV-infected patients (6/8 (75.0%) vs. 4/22 (18.2%), p<0.01). Three of eight HBV-infected patients were initially negative for hepatitis B surface antigen (HBsAg) by latex agglutination and became positive for HBsAg during chemotherapy. Furthermore, all three patients developed severe liver dysfunction and two developed fatal fulminant hepatitis. From an examination of the original stock of serum samples before chemotherapy, two patients were found to be positive for HBV-DNA by polymerase chain reaction (PCR). Although post-transfusion HBV infection was suspected in the one remaining patient, the cause of HBV infection could not be clarified due to the impossibility of examination in blood donors. Since HBV-infected patients develop severe liver dysfunction at a higher incidence than either patients not infected with virus or HCV-infected patients before chemotherapy for hematological malignancies, it is recommended that HBV-DNA should be tested by PCR to detect HBV marker-negative carriers and liver function tests should be carefully monitored.

HBV reactivation with fatal fulminating hepatitis during rituximab treatment in a subject negative for HBsAg and positive for HBsAb and HBcAb

“…[1][2][3] These reactivations have been observed, especially in hepatitis B surface antigen (HBsAg)-positive subjects 4 and they occur in 20%-50% of cases, with a mortality rate of 10%-40%. Consequently, lamivudine prophylaxis is strongly recommended in HBsAg-positive subjects receiving chemotherapy or immunosuppressive therapy, [5][6][7] although there are no clear guidelines for HBsAg-negative subjects.…”

Development of de novo hepatitis B in patient during follow-up of liver-graft-versus-host disease associated with allogeneic peripheral blood stem cell transplantation

“…Such a condition due to HBV reactivation in the HBs antigen or HBV-DNA negative state is referred to as de novo hepatitis B. [4][5][6] A study conducted in Japan has recently demonstrated the higher incidence of de novo hepatitis B becoming fulminant hepatitis than of the common acute hepatitis B with a higher mortality rate. [7] And also, the guideline for the prevention and treatment of HBV reactivation during immunosuppressive drug therapy was developed by the Clinical Practice and Quality Measures Committee (currently the Clinical Practice Guideline Committee) and approved by the AGA Governing Board.…”

“…However, it has been reported that, even in this state, some patients develop fatal severe hepatitis owing to HBV reactivation following immunosuppressive therapy for the treatment of various diseases including cancer, autoimmune disease, and organ transplant and that this hepatitis has been referred to as de novo hepatitis B. [4][5][6] Because the rates of fulminant hepatitis B and fatal hepatitis B are high among de novo hepatitis patients, [7] a careful follow-up is also recommended for patients with a resolved HBV infection and who underwent immunosuppressive therapy.…”

Hepatitis C Virus Related Liver Dysfunction During Chemotherapy for Hodgkin’s Lymphoma

“…7,8,12 However, 7-30% of the HCV-positive lymphoma patients experience HCV related hepatotoxicity secondary to chemotherapy. 6 In a study, liver enzyme abnormalities during chemotherapy for malignancies were seen in 54% of the HCV-positive patients, and in 34% of the HCV-negative patients.…”