The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Reactivation of Hepatitis B Virus Following Systemic Chemotherapy for Malignant Lymphoma

악성 림프종 환자에서 항암화학요법 후 발생하는 B형 간염의 재활성화

  • Jang, Seung Jun (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Jung, Young Kul (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Baek, Hae Lim (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Yoon, Hyun Hwa (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Shin, Seung Kak (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Hong, Jun Shik (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Park, Jin Ny (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kwon, Oh Sang (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kim, Yun Soo (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Choi, Duck Joo (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Lee, Jae Hoon (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center) ;
  • Kim, Ju Hyun (Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center)
  • 장승준 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 정영걸 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 백혜림 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 윤현화 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 신승각 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 홍준식 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 박진희 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 권오상 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 김연수 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 최덕주 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 이재훈 (가천대학교 길병원 내과학교실 소화기내과) ;
  • 김주현 (가천대학교 길병원 내과학교실 소화기내과)
  • Received : 2013.03.19
  • Accepted : 2013.05.31
  • Published : 2013.12.01
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Abstract

Background/Aims: Reactivation of hepatitis B virus (HBV) has been reported in HBV surface antigen (HBsAg)-positive patients undergoing chemotherapy, as well as HBsAg-negative patients with antibodies against HBV core antigen (HBcAg) and/or HBsAg (HBsAb). Chemotherapy-including rituximab-has recently been identified as a predictive factor for HBV reactivation in HBsAg-negative patients with malignant lymphoma. The aim of our study was to identify the factors predictive of HBV reactivation after chemotherapy in patients with malignant lymphoma. Methods: We conducted a retrospective analysis of medical records from patients diagnosed with malignant lymphoma at Gachon University Gil Medical Center in City, County from January 2005 to December 2010. We subsequently determined HBsAg, HBsAb and anti-HBc status in the 196 patients treated with chemotherapy. Results: The mean age of the patients was 57.3 ${\pm}$ 14.5 years; 56.3% were male. A total of 172 of 196 (88%) patients in the study population were HBsAg (+) prior to chemotherapy. Three patients (3/11, 27.3%) in the HBsAg (+) group had confirmed HBV reactivation after chemotherapy. In addition, 26 of 196 (13%) patients in the study population tested HBcAg (+) positive prior to chemotherapy. One patient (1/15, 6.7%) in the HBsAg (-)/HBcAb (+) group had confirmed HBV reactivation. In the four patients with HBV reactivation, infection was resolved after treatment with 0.5 mg entecavir or 100 mg lamivudine. Conclusions: Reactivation of HBV after systemic chemotherapy can occur in HBsAg (-) patients. We recommend that malignant lymphoma patients undergoing chemotherapy be screened for HBV infection status, including HBcAg, and followed closely to prevent HBV reactivation.

목적: 악성 림프종 환자에서 항암 치료 후 발생하는 B형 간염의 재활성화는 중요한 합병증 중 하나이다. 이러한 B형 간염의 재활성화는 항암 치료의 연기 혹은 심각한 간부전을 초래함으로써 결국 악성 림프종 환자의 생존율에 악영향을 준다. B형 간염의 재활성화는 항암 치료 전 검사에서 HBsAg 양성인 환자뿐만 아니라 HBsAg 음성인 환자에서도 발생할 수 있다. 실제로 HBsAg이 음성일지라도 과거 B형 간염을 앓았거나 잠재감염 상태인 환자는 anti-HBc 양성 소견을 보인다. 본 연구는 단일 의료센터에서 6년간 항암 치료를 받은 196명의 환자를 후향적으로 분석하여 B형 간염의 재활성화율과 이를 예방하기 위한 방법에 대해 알고자 한다. 방법: 2005년 1월부터 2010년 12월까지 가천대 길병원에서 악성 림프종을 진단받고 항암 치료를 시행받은 196명이 환자들의 검사 결과 및 임상경과 자료를 후향적 분석하였다. 결과: 악성 림프종을 진단받은 총 196명의 환자에 대해 항암 치료 전 HBsAg 검사율은 88% (172/196)였으며 11명이 양성이었다. Anti-HBc 검사율은 13% (26/196)에 그쳤으며 HBsAg 음성이면서 Anti-HBc 양성인 환자는 15명이었다. 재활성화는 HBsAg 양성군에서 27.3% (3/11), HBsAg 음성군에서 6.7% (1/15) 발생하였으며 이들은 entecavir 혹은 lamivudine 복용 후에 모두 후유증 없이 간기능을 회복하였으며 항암 치료를 종료하였다. 결론: HBsAg 양성인 환자뿐만 아니라 과거감염이나 회복된 감염을 의미하는 Anti-HBc 양성인 환자에서도 재활성화는 발생하였다. 따라서 항암 치료 시작 전에 B형 간염 바이러스에 대한 상태를 평가하고 재활성화를 예방하기 위한 적절한 검사와 선제 치료가 필요하다.

Keywords

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