300 690
B
B ( chemotherapy )
B ( hepatitis B virus reactivation )
B B
( preemptive lamivudine ) B
3 ( lamivudine ) ( CBC/DC )
ALT HBV-DNA YMDD ( lamivu-
dine withdrawal hepatitis ) B
10-15% B HBsAg
B ( Hepatitis B virus reactivation ) ( Lamivudine )
( Preemptive lamivudine ) ( Chemotherapy )
B
B B 10-15%
B 24-78%1-14 B
4-63%
B B
B
H B V - D N A
HBeAg ( precore/core promoter muta- t i o n )
HBsAg ( + ) HBV-DNA ( + )
( preemptive lamivudine )
Y M D D
( withdrawal hepatitis )
B
B
HBsAg Anti-HBc HBsAg ( - ) /Anti-HBc ( - ) B
HBsAg ( + ) /Anti-HBc ( + ) B HBeAg HBV-DNA
( 1 ) HBeAg ( + ) / HBV-DNA ( + ) Wild type HBV
( 2 ) HBeAg ( - ) / HBV-DNA ( + )
( precore/core promoter mutation ) HBsAg ( - ) /Anti-HBc ( + )
B ( occult HBV )
HBV-DNA Anti-HBs
( 1 ) HBV-DNA ( + ) Anti-HBs
( + ) ( - ) B
( preemptive lamivudine ) 1,15-19 ( 2 ) HBV-DNA ( - ) Anti-HBs ( + )
B
( p e r i p h e r a l mononuclear cell )
B
2 HBV-DNA1
B
20-28
B
B
B ( 44% )4
( 32% )
B 4 , 2 9 - 3 1
HBV-DNA 10 HBV-
DNA HBV-DNA
1000 106copies/ml
HBV-DNA 1-2
( median range 0-11 )
A LT 2 9 , 3 2
( ALT 2-3 ALT 100
IU/L ) ( pre-
emptive lamivudine ) ( 2-4 )
HBV-DNA B
24% ( ALT )
41% ( ALT + HBV-DNA )14
B 9,11,12
(
) B
Cytotoxic-T-lym-
phocyte B
B
B
B
B 1975
33,34
24-78%1-14
( ) B
( 1995 ) ALT
2-3 ALT 100 IU/L B
HBV-DNA
1. B
2.B
3.B ( ALT
2-3 ALT 100 IU/L ) 4.B
( )
( ) HBV-DNA HBeAg ( + ) ( precore/core promoter )
( ) B
2-3 4
( median 16 range 4-36
) 1,8,9,35-37
B
11,61,62
B ( ) B
10-63%1,2,5,6,38-41
( ) B
4-60%1,2,5,6,13,14,19,20,31,38-45
B
HBsAg ( + ) HBV- DNA ( + )
B 24-78%4,7,30,46,47
solid tumor 4,48,49
B 1 0 -
55%8,14,32,50,51
( small
cell ) 30%4
HBV-DNA
HBV-DNA 104 copies/ml
B 51,59,60
1 9 , 2 4 , 5 1 - 5 7
( w i t h - drawal hepatitis )
( ) Steroid 1,5,11,19,41,58
B 11,61,62
7,12,29,30
( ) Anthracyclines 4,7,19,30,32
Doxorubicin Epirubicin Daunorubicin Idarubicin
( ) 18,63-73
Rituximab ( Anti-CD20 ) Alemtuzmab ( Anti-CD52 ) Infliximab ( Anti-TNF )
B
( 16 )
occult HBV
( 6-12 )
HBeAg ( + )10,28,73
HBeAg ( + ) B
HBV-DNA B
B
HBV-DNA ( - )
9,12,19,59,60,74
B 37-57%
B HBsAg ( - )
75-80
B
( Preemptive lamivu- dine )
B
24-78% 10-63%
4-60%
B
B 0-8.7%7,9,19,60,81
( Rescue therapy ) B
B
( )
1-2 HBV-DNA 104 copies/ml
14-75%4,29,36,39,73,82,83
( 2-4 ) ALT HBV-
-DNA 14,29 ALT
A L T
( Adefovir Entecavir )
HBsAg ( + ) HBV-DNA ( + )
2-3 69
(
CBC/DC platelet ) 1-12
( APASL ) 3
6-12 1,19,37,44,69,85-87
( withdrawal hepatitis ) B
( ) HBV-DNA 104copies/ml52 ( ) ( precore/core promoter muta- tion )
( ) 1-12
HBV-DNA 104 copies/ml HBeAg ( + )
( ) ( Rituximab )
( )
( )
CBC/DC ALT Bilirubin PT
6-9 HBV-
DNA YMDD
A L T CBC/DC HBV-DNA
( )
A LT B
4 HBV-DNA
29 HBV-DNA
A LT
B
HBsAg ( + ) HBV-DNA ( + ) ( )
3
( preemptive ) ( rescue therapy )
H B V ( Entecavir Adefovir )
H B s A g Anti-HBc
B Anti-HBc
Anti-HBc ( + )
B HBV-DNA ( + )
HBV-DNA ( - ) HBsAg ( - ) Anti- HBs ( + )
HBV-DNA
( 2006 11 1 )
( ) B HBsAg ( + )
B
B 4-60%
( ) B HBsAg ( + )
B
( ) B
( S L E
Pulse therapy ) B
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Prevention and Management of Hepatitis B Virus Reactivation in Cancer Patients
Undergoing Chemotherapy
Chung-Chu Chen, Po-Chuan Wang, Han-Wen Chang, and Ching-Fu Chen
For cancer patients receiving cytotoxic chemotherapy, hepatitis B virus reactivation is well-described com- plication resulting in varying degree of liver damage. Therefore, we discuss how to prevent and manage the HBV reactivation in cancer patients undergoing chemotherapy; analyze the risk factors of HBV reactivation.
According to the evidence-base medicine: The prophylactic, preemptive lamivudine significantly decreases the incidence of HBV reactivation, morbidity and disruption of chemotherapy. So the HBsAg or HBV-DNA positive patients are recommended the preemptive lamivudine before initiation of chemotherapy. The treatment was then continued throughout the course of chemotherapy for at least 3 months after discontinuation of chemotherapy and when the total white cell counts had become normalized. If the physician and patient do regular follow up carefully, it is not difficult to deal with the YMDD mutation and withdrawal hepatitis after cessation of preemptive lamivudine. ( J Intern Med Taiwan 2007; 18: 236- 243 )
Division of Hepatology & Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Hsin-Chu, Taiwan, R.O.C.
