Reactivation of hepatitis B virus infection 66 months after rituximab therapy for chronic lymphocytic leukemia, emphasis on interplay between infection, drugs and disease biology
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Date
2019
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Yuzuncu Yil Universitesi Tip Fakultesi
Access Rights
info:eu-repo/semantics/openAccess
Abstract
Hepatitis B virus (HBV) reactivation (HBVr) in patients receiving immunosuppression is an evolving topic. American Gastroenterology Association (AGA) have reported a guideline for the management of patients with certain HBV status who will undergo immunosuppression with regard to patient’s HBV status as well as the category and duration of immunosuppression. Here we are presenting a case with CLL who have received rituxmab with bendamustine 66 months before, developing HBVr with an emphasis on the discussion pathophysiological process of the disease itself, not just the treatment course. 59 years old male patient diagnosed with CLL and chronic asymptomatic HBV infection received 3 lines of treatment under viral prophylaxis in 13 years. 66 months after the last treatment with rituximab, HBV reactivation developed and treated with dual antiviral therapy. During this period a decrease in lymphocyte count was observed concurrent with transaminase elevation. As the reactivation was controlled, lymphocyte counts increased back to pre-flare levels. While the patient had impaired antibody related immune response since monoclonal B cells are nonfunctional, an attempt to improve T cell related response may be resulted with both to t he clearance of lymphocytes (as they were decreased) and the immune reaction of necroinflammation in the hepatocytes were triggered. © 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.
Description
Keywords
Chronic Lymphocytic Leukemia; Hepatitis B Reactivation; Rituximab, Alanine Aminotransferase; Aspartate Aminotransferase; Bendamustine; Cyclophosphamide; Fludarabine; Hemoglobin; Hepatitis B Surface Antigen; Lamivudine; Rituximab; Tenofovir; Virus Antibody; Adult; Antibody Titer; Article; Case Report; Chronic Lymphatic Leukemia; Clinical Article; Fluorescence In Situ Hybridization; Follow Up; Gene Deletion; Hepatitis B; Hepatitis B Virus; Human; Immunoglobulin Deficiency; Leukocyte Count; Lymphocyte Count; Male; Middle Aged; Monoclonal B Cell Lymphocytosis; Multiple Cycle Treatment; Pathophysiology; Platelet Count; Prothrombin Time; Treatment Duration; Virus Reactivation
Journal or Series
Eastern Journal of Medicine
WoS Q Value
Scopus Q Value
Q4
Volume
24
Issue
3
