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[Successful interferon-alpha treatment of hepatitis B developing during chemotherapy of malignant lymphoma]
1First Department of Internal Medicine, Toho University School of Medicine, Tokyo.
Insights
This study highlights a successful treatment approach for a lymphoma patient with an asymptomatic hepatitis B carrier status. Early interferon-alpha administration prevented severe liver damage during chemotherapy, leading to lymphoma remission and hepatitis B seroconversion.
Area of Science:
- Oncology
- Hepatology
- Virology
Background:
- Malignant lymphoma (diffuse large cell type) in an asymptomatic hepatitis B carrier.
- Patient presented with stage IIA lymphoma and positive hepatitis B antigen.
Observation:
- Chemotherapy (COP-BLAM) initiation led to elevated liver enzymes (GOT, GPT) and serum DNA polymerase.
- Interferon-alpha was administered due to rising liver dysfunction and viral activity.
Findings:
- Interferon-alpha treatment normalized serum DNA polymerase and induced hepatitis B e-antibody seroconversion.
- Modified chemotherapy (COP-BLAM without prednisolone) achieved complete remission of lymphoma.
Implications:
- Early interferon-alpha use is crucial for managing hepatic dysfunction in lymphoma patients who are hepatitis B carriers.
- This strategy can enable continued chemotherapy, leading to successful lymphoma treatment and viral seroconversion.
Abstract:
In a 47-year-old male patient a tonsillar swelling was pointed out in May, 1991. Lymph node biopsy revealed that he had malignant lymphoma (diffuse large cell type). He had no hepatic dysfunction on admission, but because of positive hepatitis B (HB) antigen and negative HB antibody, he was diagnosed as an asymptomatic HB carrier. The staging examination showed that he had stage IIA lymphoma. Treatment with the COP-BLAM regimen was initiated on June 8. But the level of serum GOT and GPT increased to 286 IU/l and 392 IU/l, respectively. Serum DNA polymerase also increased to 9492 cpm. Interferon-alpha (3 x 10(6) units daily) was administered intramuscularly from June 8. Serum DNA polymerase decreased to zero on September 2, and his HBe antibody became positive indicating seroconversion. COP-BLAM chemotherapy without prednisolone was initiated from September 9 and complete remission was achieved. He was discharged from our hospital on September 25. It has been frequently reported that asymptomatic HB antigen carriers developed fulminant hepatitis during the course of chemotherapy. Our case suggests that it is necessary to continue chemotherapy in order to attain seroconversion by early use of interferon-alpha, when lymphoma patients display aggravated hepatic dysfunction and increased DNA polymerase levels.