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[Chemotherapy with concomitant IFN treatment in three HBV carriers (mutant strain) with malignant lymphoma]
N Niitsu1, M Nakayama, M Umeda
1First Department of Internal Medicine, Toho University School of Medicine.
Insights
Hepatitis B virus (HBV) carriers with lymphoma receiving chemotherapy and interferon (IFN) showed normalized liver enzymes. Early detection of HBV DNA polymerase elevation allowed timely IFN administration, preventing severe liver damage.
Area of Science:
- Hepatology
- Oncology
- Virology
Background:
- Hepatitis B virus (HBV) infection poses risks during chemotherapy for malignant lymphomas, particularly in HBsAg+ patients with specific antibody profiles (HBsAb-, HBcAb+, HBeAg-, HBeAb+), often associated with mutant strains.
- Multidrug chemotherapy (CO-BLAM) combined with interferon (IFN) was administered to three such patients.
Observation:
- Patients with malignant lymphomas and HBV infection (HBsAg+, HBeAb+ mutant strain) underwent intensive chemotherapy and IFN therapy.
- Hepatitis B virus DNA polymerase (DNA-P) levels were monitored, alongside liver enzymes (GOT, GPT).
- Elevated DNA-P preceded elevations in GOT and GPT, indicating early viral activity.
Findings:
- Complete response to CO-BLAM chemotherapy was achieved in all patients.
- Early administration of IFN-alpha, triggered by DNA-P elevation, effectively normalized DNA-P, GOT, and GPT levels.
- Timely IFN intervention prevented the development of severe hepatitis in all three cases.
Implications:
- Monitoring HBV DNA polymerase is crucial for predicting and preventing chemotherapy-induced liver injury in HBV carriers.
- Interferon-alpha is an effective therapeutic agent for managing HBV reactivation during lymphoma treatment.
- Identifying HBV mutant strains may guide treatment strategies for HBsAg+ and HBeAb+ patients.
Abstract:
Intensive multidrug chemotherapy with concomitant IFN was performed in three hepatitis B virus (HBV) carriers with malignant lymphomas. All of the patients were HBsAg+, HBsAb-, HBcAb+, HBeAg- and HBeAb+ (mutant strain+). HBV-DNA polymerase (DNA-P) was normal at the beginning of chemotherapy, and complete response was achieved with CO-BLAM chemotherapy (without PDN) in all cases. In case 1, a slight elevation of DNA-P and normal GOT and GPT was observed after IFN-alpha was started during the third course. IFN-alpha was administered twice a week. In case 2, elevation of DNA-P and normal GOT and GTP were noted at the end of the 5th course, then daily IFN-alpha was started. In case 3, daily IFN-alpha was started during the 3rd course because of elevation of DNA-P. It was possible to prevent severe liver damage by administering IFN immediately after the elevation of DNA-P, since DNA-P elevation is noted before GOT and GPT elevation. The detection of the HBV mutant strain could be helpful in the treatment of HBsAg+ and HBeAb+ patients. In all of three patients, DNA-P, serum GOT and GPT normalized quickly after the administration of IFN-alpha. Severe hepatitis did not develop.