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

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.