Reactivation of Hepatitis B Virus in Patients with Multiple Myeloma

Tsukune, Yutaka; Sasaki, Makoto; Komatsu, Norio

doi:10.3390/cancers11111819

Cited by 8 publications

(4 citation statements)

References 94 publications

(164 reference statements)

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“…Therefore, it is likely that this patient achieved HBsAg clearance by combined treatment with bortezomib and entecavir, rather than spontaneous clearance. However, some studies have shown that about 20% of the patients develop HBV reactivation 2 years after initiation of bortezomib treatment, [23] even in patients with resolved HBV infection. [1] Therefore, it remains to be seen whether HBV clearance will be maintained in this patient in the future.…”

Section: Discussionmentioning

confidence: 99%

Clearance of HBsAg in a patient with familial multiple myeloma after a bortezomib-based regimen combined with anti-HBV drug

Zhang

Liang²,

Li³

et al. 2020

Medicine

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Rationale: Reactivation of hepatitis B virus (HBV) after treatment with bortezomib-based regimens in HBV-positive patients with multiple myeloma (MM) has been reported in the past few years. Nevertheless, there is evidence of inhibition of HBV replication by bortezomib in transgenic mice. However, there is still no clinical evidence that bortezomib inhibits HBV. Patient concerns: A 55-year-old MM patient with a family history of MM, who was also a chronic HBV carrier, achieved HBV clearance after treatment with a bortezomib-based regimen in combination with anti-HBV drugs. Diagnoses: The diagnosis was MM with chronic carrier of HBV. Interventions: He received bortezomib-based regimen for MM as well as entecavir as a prophylaxis to prevent HBV reactivation. Outcomes: This patient achieved HBsAg and HBV-DNA clearance after 2 months and the remission was maintained during the next 2 years. He also achieved complete remission of MM and underwent consolidation therapy with autologous hematopoietic stem cell transplantation. Lessons: This is the first case of MM with HBV clearance after receiving a bortezomib-based regimen combined with anti-HBV drug. Research on related mechanisms might provide new suggestions and hope for better management of HBV positive patients with MM and for the treatment of HBV patients.

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Section: Discussionmentioning

confidence: 99%

Clearance of HBsAg in a patient with familial multiple myeloma after a bortezomib-based regimen combined with anti-HBV drug

Zhang

Liang²,

Li³

et al. 2020

Medicine

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“…HBV reactivation can cause severe hepatitis and lead to fatal fulminant hepatitis. Antiviral prophylaxis from initiation of MM therapy is recommended and monitoring HBV markers is crucial for older MM HBV-positive patients ( 88 ).…”

Section: Treatment Choice and Dose Intensitymentioning

confidence: 99%

Approaches and Challenges in the Management of Multiple Myeloma in the Very Old: Future Treatment Prospects

2021

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The increasing incidence of geriatric patients with multiple myeloma has elevated concerns in clinical practice. While the introduction of novel therapeutic agents has substantially improved outcomes in younger patients with myeloma, poorer outcomes remain in older patients. Managing older patients requires a multidisciplinary team approach to consider factors that may influence both treatment selection and outcomes. Aging is associated with remodeling of vital organs, physiological downregulations of basal metabolism, susceptibility to multiple comorbidities with ultimate frailty, thereby contributing to the underrepresentation and exclusion of very old patients from clinical trials. Therefore, timely confirmation of a precise diagnosis is crucial for prompt initiation of treatment if the desired outcome is to be achieved. Adequate and judicious assessment using comprehensive geriatric assessment tools minimizes toxicities and treatment discontinuation. Initiating treatment with combinational therapy requires knowledge of indications and anticipated outcomes, as well as individualized therapy with appropriate dose-adjustment. Individualized therapy based on good clinical acumen and best practices obverts unwanted polypharmacy, preventing iatrogenic harm. This review will therefore address the approaches and challenges faced in managing myeloma in geriatric patients aged 80 years and older, highlighting recommended therapeutic strategies and future prospective regimens.

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“…This Special Issue includes two reviews describing the complications associated with MM [14,15]. The reactivation of hepatitis B virus (HBV) during or after cytotoxic chemotherapy is a well-known complication in patients with hematological malignancies.…”

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confidence: 99%

“…There is a preventive strategy for HBV reactivation in patients with malignant lymphoma; however, it is yet to be established in patients with MM. On reviewing the Japanese nationwide retrospective survey of HBV reactivation in MM patients, Tsukune et al found that HBV reactivation in MM patients is not rare and that ASCT should be considered as a risk factor [14]. Approximately 20% of MM patients show HBV reactivation 2 years after the initiation of therapy, unlike malignant lymphoma.…”

mentioning

confidence: 99%