A non-Hodgkin lymphoma patient with reactivation of HBV during chemotherapy and emergence of a YMDD-motif mutant on lamivudine, eventually controlled by adfovil dipovoxil

Abstract

A 56-year-old man underwent chemotherapy for non-Hodgkin lymphoma (NHL) including rituximab, a chimeric monoclonal anti-CD20 antibody. He was a hepatitis B virus (HBV) carrier, and the HBV-DNA in his serum increased during the chemotherapy, but returned to an undetectable level as soon as he was administrated lamivudine. He got complete remission as for NHL and started rituximab alone for adjuvant therapy. He then had hepatitis caused by HBV reactivation just after administration of rituximab. A YMDD (M204V) mutant was detected from him, so we prescribed adefovil dipivoxil added to lamivudine. His hepatitis was slightly prolonged, but HBV-DNA was reduced gradually, and hepatitis was improved. He maintains normal transaminase levels with undetectable HBV-DNA now at 15 months after the breakthrough hepatitis.