Viral Hepatitis
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2005; 11(34): 5283-5288
Published online Sep 14, 2005. doi: 10.3748/wjg.v11.i34.5283
Long-term hepatic consequences of chemotherapy-related HBV reactivation in lymphoma patients
Wen-Pin Su, Chi-Chung Wen, Chao A. Hsiung, Ih-Jen Su, Ann-Lii Cheng, Ming-Chih Chang, Chao-Jung Tsao, Woei-Yao Kao, Wu-Ching Uen, Chiun Hsu, Chih-Hung Hsu, Yen-Shen Lu, Hwei-Fan Tien, Tsu-Yi Chao, Li-Tzong Chen, Jacqueline Whang-Peng, Pei-Jer Chen
Wen-Pin Su, Ann-Lii Cheng, Chiun Hsu, Chih-Hung Hsu, Yen-Shen Lu, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan, China
Chi-Chung Wen, Chao A. Hsiung, Division of Biostatics and Bioinformatics, National Health Research Institutes, Taipei, Taiwan, China
Ih-Jen Su, Division of Clinical Research, National Health Research Institutes, Taipei, Taiwan, China
Ann-Lii Cheng, Hwei-Fan Tien, Pei-Jer Chen, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, China
Ming-Chih Chang, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, China
Chao-Jung Tsao, Department of Internal Medicine, Chi-Mei Hospital, Tainan, Taiwan, China
Woei-Yao Kao, Tsu-Yi Chao, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan, China
Wu-Ching Uen, Department of Internal Medicine, Shin Kong Memorial Hospital, Taipei, Taiwan, China
Li-Tzong Chen, Jacqueline Whang-Peng, Division of Cancer Research, National Health Research Institutes, Taipei, Taiwan, China
Pei-Jer Chen, Clinical Research Institute, National Taiwan University College of Medicine, Taipei, Taiwan, China Supported by the National Health Research Institute, Taiwan, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Ann-Lii Cheng, MD, PhD, Professor, Departments of Oncology and Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 10016, Taiwan, China. andrew@ha.mc.ntu.edu.tw
Telephone: +886-2-2312-3456-7251 Fax: +886-2-2371-1174
Received: February 22, 2005
Revised: March 20, 2005
Accepted: March 23, 2005
Published online: September 14, 2005
Abstract

AIM: To investigate the long-term consequences of chemotherapy-related HBV reactivation in patients with lymphoma.

METHODS: This study was based on the database of published prospective study evaluating HBV reactivation in HBV lymphoma patients during chemotherapy. Deteriorated liver reserve (DLR) was defined as development of either one of the following conditions during follow-up: (1) newly onset parenchyma liver disease, splenomegaly or ascites without evidence of lymphoma involvement; (2) decrease of the ratio (albumin/globulin ratio) to less than 0.8 or increase of the ratio of INR of prothrombin time to larger than 1.2 without evidence of malnutrition or infection. Liver cirrhosis was diagnosed by imaging studies.

RESULTS: A total of 49 patients were included. The median follow-up was 6.2 years (range, 3.9-8.1 years). There were 31 patients with and 18 patients without HBV reactivation. Although there was no difference of overall survival (OS) and chemotherapy response rate between the two groups, DLR developed more frequently in patients with HBV reactivation (48.4% vs 16.7%; P = 0.0342). Among the HBV reactivators, HBV genotype C was associated with a higher risk of developing DLR (P = 0.0768) and liver cirrhosis (P = 0.003). Four of five patients with sustained high titer of HBV DNA and two of three patients with multiple HBV reactivation developed DLR. Further, patients with a sustained high titer of HBV DNA had the shortest OS among the HBV reactivators (P = 0.0000). No patients in the non-HBV reactivation group developed hepatic failure or liver cirrhosis.

CONCLUSION: Chemotherapy-related HBV reactivation is associated with the long-term effect of deterioration of hepatic function.

Keywords: HBV reactivation, Liver function, Non-Hodgkin’s lymphoma, Chemotherapy