Bortezomib Induced Hepatitis B Reactivation

Abstract

Background. It has recently been reported that hepatitis B (HBV) reactivation often occurs after the use of rituximab and stem cell transplantation in patients with lymphoma who are hepatitis B surface antigen (HBsAg) negative. However, clinical data on HBV reactivation in multiple myeloma (MM) is limited to only a few reported cases. Bortezomib and lenalidomide have remarkable activity in MM with manageable toxicity profiles, but reactivation of viral infections may emerge as a problem. We present a case of MM that developed HBV reactivation after bortezomib and lenalidomide therapy. Case Report. A 73-year-old female with a history of marginal cell lymphoma was monitored without requiring therapy. In 2009, she developed MM, presenting as a plasmacytoma requiring vertebral decompression and focal radiation. While receiving radiation she developed renal failure and was started on bortezomib and liposomal doxorubicin. After a transient response to 5 cycles, treatment was switched to lenalidomide. Preceding therapy initiation, her serology indicated resolved infection. Serial monitoring for HBV displayed seroconversion one month after change in therapy. Conclusion. Bortezomib associated late HBV reactivation appears to be a unique event that requires further confirmation and brings to discussion whether hepatitis B core positive individuals would benefit from monitoring of HBV activation while on therapy.

Hepatitis B reactivation in multiple myeloma patients with resolved hepatitis B undergoing chemotherapy

“…Therefore, bortezomib, mainly by inhibition of the NF‐κB pathway, may increase the risk of viral infections. Clinical data on HBV reactivation in patients receiving bortezomib in MM are limited to only a few reported cases . Li et al .…”

Severe Acute Hepatitis B in HBV-Vaccinated Partner of a Patient with Multiple Myeloma Treated with Cyclophosphamide, Bortezomib, and Dexamethasone and Autologous Stem Cell Transplant

“…Interestingly, our patient in Case 1 developed HBsAg seroreversion with only transient hepatitis before entering what looked like the immune tolerant phase. There have only been 2 previous reported cases of patients with MM who received Bortezomib and had HBV reactivation followed directly by an immunotolerant phase [10, 11]. …”

“…ASCT has also been raised as a risk factor for HBV reactivation [15]. Bortezomib, a proteasome inhibitor, has been previously reported in a few cases of HBV reactivation in MM patients [10, 11]. Given its mechanism of action, Bortezomib may impair intracellular viral antigen processing leading to impaired maintenance of T-cell memory [16].…”

“…A few recent studies have reported cases of HBV reactivation in patients with MM being treated with Bortezomib-based chemotherapy [10, 11]. Tsukune et al reported 9 patients with MM who received Bortezomib-based chemotherapy and developed HBV reactivation [12].…”

Injury pattern recognition to discriminate competing causes of liver injury

“…Hepatitis B virus reactivation occurred 4‐24 months after bortezomib was started. Four patients had evidence of prior resolved infection with positive HBsAb seroreversion during their disease course . The reactivation in two of the cases was identified early due to close HBV DNA monitoring and immediate start of antiviral therapy at occurrence of HBV DNA positivity prevented hepatitis .…”