Hepatitis B Reactivation Rate and Fate Among Multiple Myeloma Patients Receiving Regimens Containing Lenalidomide and/or BortezomibPınar Ataca Atilla1, Merih Yalçıner2, Erden Atilla1, Ramazan İdilman3, Meral Beksaç11Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
2Ankara University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
3Ankara University Faculty of Medicine, Department of Gastroenterology, Ankara, Turkey
Objective: Reactivation of the hepatitis B virus (HBV) refers to an increase in HBV replication in a patient with inactive or resolved HBV. In this retrospective study, our aim is to present and compare HBV reactivation in multiple myeloma (MM) patients who received lenalidomide and/or bortezomib at any time during treatment, evaluate the factors associated with reactivation, and demonstrate the outcome of patients.
Materials and Methods: We evaluated 178 MM patients who received lenalidomide (n=102) and/or bortezomib (n=174) during their treatment schedules. The HBsAg, anti-HBc, anti-HBs, HBeAg, and anti-HBe were detected by chemiluminescence by ARCHITECT lab analyzers using commercially available kits (Abbott, USA). HBV-DNA titers were determined by quantitative PCR. The results were evaluated by IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA).
Results: HBV reactivation was diagnosed in 6 patients (3%) after bortezomib and in 8 patients (8%) after bortezomib and lenalidomide. Three of the patients in each group had HBsAg+, HBeAg+, AntiHBeAg-, AntiHBc-, and AntiHBS+ status, whereas 5 patients in the bortezomib- and lenalidomide-treated group and 3 patients in the bortezomib-treated group had HBsAg-, HBeAg-, AntiHBeAg-, AntiHBc-, and AntiHBS+ status prior to treatment. There were no statistical differences observed between HBV reactivation in the bortezomib-treated or bortezomib- and lenalidomide-treated groups in terms of age at diagnosis, sex, International Staging System subtype, frequency of extramedullary disease, dialysis requirement, or receiving of autologous stem cell transplantation. In patients who received antiviral prophylaxis, a higher incidence of HBV reactivation was detected in HBsAg-positive patients compared to HBsAg-negative patients (4/4, 100% vs. 2/7, 29%; p=0.045). The 3-year and 5-year overall survival rates were similar in patients with or without HBV reactivation (83% vs. 84%, 73% vs. 74%, p=0.84).
Conclusion: Close follow-up is recommended for not only HBsAgpositive but also HBsAg-negative patients.
Keywords: Hepatitis B reactivation, Bortezomib, Lenalidomide, Multiple myeloma, Antiviral therapy
Lenalidomid ve/veya Bortezomib İçeren Tedavi Alan Multipl Myelom Hastalarında Hepatit B Reaktivasyon Sıklığı ve SonuçlarıPınar Ataca Atilla1, Merih Yalçıner2, Erden Atilla1, Ramazan İdilman3, Meral Beksaç11Ankara University Faculty of Medicine, Department of Hematology, Ankara, Turkey
2Ankara University Faculty of Medicine, Department of Internal Medicine, Ankara, Turkey
3Ankara University Faculty of Medicine, Department of Gastroenterology, Ankara, Turkey
Amaç: Hepatit B virüs (HBV) reaktivasyonu, HBV enfeksiyonunun inaktifleştiği veya iyileştiği hastalarda virüs replikasyonunun artışıdır. Bu geriye dönük çalışmada amacımız tedavilerinin herhangi bir döneminde lenalidomid ve/veya bortezomib alan multipl myelom (MM) hastalarında HBV reaktivasyonunu göstermek, reaktivasyonla ilişkili faktörleri ve sağkalımlarını değerlendirmektir.
Gereç ve Yöntem: Tedavileri sırasında lenalidomid (n=102) ve/ veya bortezomib (n=174) alan 178 MM hastası değerlendirilmiştir. ARCHITECT lab analiz cihazlarıyla HBsAG, anti-HBc, anti-HBs, HBeAg, anti-HBe piyasada bulunan kitlerle (Abbott, ABD) kemiluminesans yoluyla, HBV-DNA titreleri kuantitative PCR ile tespit edilmiştir. Sonuçların değerlendirilmesinde IBM SPSS 20.0 (IBM Corp., Armonk, NY, ABD) kullanılmıştır.
Bulgular: HBV reaktivasyonu, bortezomib kullanan 6 hastada (%3) ile bortezomib ve lenalidomid alan 8 hastada (%8) tespit edilmiştir. Tedavi öncesi iki gruptan 3 hastada HBsAg+, HBeAg+, AntiHBeAg-, AntiHBc-, ve AntiHBS+ saptanırken, bortezomib ve lenalidomid alan 5 hastada ve sadece bortezomib alan 3 hastada HBsAg-, HBeAg-, AntiHBeAg-, AntiHBc-, ve AntiHBS+ saptanmıştır. Bortezomib veya bortezomib ve lenalidomid ile tedavi edilen gruplar arasında HBV reaktivasyonu ile tanı anındaki yaş, cinsiyet, evre, ekstramedüllar hastalık, diyaliz ihtiyacı veya otolog kök hücre nakil sıklığı arasında istatistiksel olarak fark saptanmamıştır. Antiviral profilaksi alan grupta, HBsAg pozitif olan hastalarda HBsAg negatif olan hastalara göre daha sık HBV reaktivasyonu tespit edilmiştir (4/4, %100 ile 2/7, %29; p=0,045). HBV reaktivasyonu gelişen ve gelişmeyen hastalarda 3-yıllık ve 5 yıllık sağkalımlar benzerdir (%83 ile %84, %73 ile %74, p=0,84).
Sonuç: Sadece HBsAg pozitif hastalar değil HBsAg negatif hastalar da yakından takip edilmelidir.
Anahtar Kelimeler: Hepatit B reaktivasyonu, Bortezomib, Lenalidomid, Multipl myelom, Antiviral terapi
Pınar Ataca Atilla, Merih Yalçıner, Erden Atilla, Ramazan İdilman, Meral Beksaç. Hepatitis B Reactivation Rate and Fate Among Multiple Myeloma Patients Receiving Regimens Containing Lenalidomide and/or Bortezomib. Turk J Hematol. 2019; 36(4): 266-273
Corresponding Author: Pınar Ataca Atilla, Türkiye |
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