多发性骨髓瘤PAD方案治疗后乙肝爆发致肝功能衰竭1例

Fulminating hepatitis-induced liver failure following treatment of multiple myelomas with PAD regimen: A case report

  • 摘要: 目的 报道1例多发性骨髓瘤用PAD方案(硼替唑咪+表柔比星+地塞米松)化疗后出现乙肝爆发的病例。 方法 2010年5月我院收住患者,女性,49岁,诊断多发性骨髓瘤IgG-λ型III期A,HbsAg(+),乙肝病毒(HBV)DNA(-),给予PAD方案(硼替唑咪1.3mg/m2第1、4、8、11天,表柔比星20mg第1、4、8、11天,地塞米松10mg第1、2、4、5、8、9、11、12天),两个疗程后出现HBV DNA(+),进行性肝功能衰竭,接受了肝移植治疗。 结果 患者已肝移植术后2年余,肝功能正常,骨髓瘤在停止治疗10个月后出现进展,给予规律小剂量化疗维持病情平稳。 结论 多发性骨髓瘤患者HbsAg(+),即使病毒阴性,化疗(含硼替唑咪等新药)后也可能爆发肝炎,宜在化疗前进行抗病毒预防治疗。

     

    Abstract: Objective To report a case of multiple myelomas who developed fulminating hepatitis following treatment with PAD regimen(bortezomib+epirubicin+dexamethasone). Methods A 49-year-old female patient,diagnosed with HBsAg(+) and HBVDNA(-) multiple myeloma IgG-λ IIIA,was treated with PAD regimen bortezomib(1.3mg/m2) and epirubicin(20mg) on days 1,4,8,and 11,and DEX(10mg) on days 1,2,4,5,8,9,11,12.The patient developed HBV DNA(+)and progressive hepatic failure after two courses of treatment and thus received liver transplantation. Results Her liver function was normal more than 2 years after liver transplantation.Her multiple myelomas deteriorated 10 months after withdrawal of treatment and became stable after regular low dose chemotherapy. Conclusion Fulminating hepatitis may occur in patients with HBsAg(+) multiple myelomas after chemothrapry with novel agents such as bortezomib even if their HBV-DNA is negative,and should receive preventive anti-virus treatment before chemotherapy.

     

/

返回文章
返回