Severe hepatitis related to chemotherapy in hepatitis B virus carriers with hematologic malignancies: Survey in Japan, 1987-1991

Authors

  • Yukari Nakamura M.D.,

    1. Fourth Department of Internal Medicine, University of Tokyo, School of Medicine, Tokyo, Japan.
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  • Toru Motokura M.D.,

    Corresponding author
    1. Fourth Department of Internal Medicine, University of Tokyo, School of Medicine, Tokyo, Japan.
    • Fourth Department of Internal Medicine, University of Tokyo, School of Medicine, 3-28-6, Mejirodai, Bunkyo-ku, Tokyo 112, Japan
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  • Akira Fujita M.D.,

    1. Department of Hematology, Showa General Hospital, Tokyo, Japan.
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  • Takayuki Yamashita M.D.,

    1. Fourth Department of Internal Medicine, University of Tokyo, School of Medicine, Tokyo, Japan.
    Current affiliation:
    1. Department of Hematology/Oncology, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
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  • Etsuro Ogata M.D.

    1. Fourth Department of Internal Medicine, University of Tokyo, School of Medicine, Tokyo, Japan.
    Current affiliation:
    1. Cancer Institute Hospital, Tokyo, Japan.
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Abstract

BACKGROUND

Hepatitis B (HB) virus (HBV) infection is often reactivated, leading to severe hepatitis and death. Because the actual incidence of such complications is unknown, the authors surveyed hospitals to record the incidence of these complications and to identify clinical parameters that would possibly predict the development of hepatic complications.

METHODS

First, 250 hospitals, belonging to the Japanese Society of Clinical Hematology, were surveyed for hematologic patients with chronic hepatitis or those with asymptomatic hepatitis virus infection in whom severe hepatitis related to chemotherapy occurred between 1987 and 1991. Second, 117 hospitals that responded to the first questionnaire were surveyed for HBV carriers without severe hepatitis who were prescribed chemotherapy.

RESULTS

One-half the number of patients with severe hepatitis were HBV carriers. The incidence of severe hepatitis (52.7%) and the mortality rate (23.6%) were extremely high in HBV carriers. The incidence of severe hepatitis was significantly higher in patients with chronic hepatitis or those receiving corticosteroids (P < 0.05). The mortality rate was significantly lower in patients who were positive for hepatitis Be antigen (HBeAg) and negative for the antibody to HBeAg (anti-HBe), compared with findings in other patients (P < 0.05).

CONCLUSIONS

HBV infection is a major causal agent for severe hepatitis related to chemotherapy in Japanese individuals. Chemotherapy, including corticosteroids, to treat hematologic malignancies should be considered risky in HBV carriers, especially those with chronic hepatitis or serologies negative for HBeAg and positive for anti-HBe. Cancer 1996;78:2210-5.

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