PMC5577071_01
On contrast abdominal computed tomography, the liver and spleen were normal in size and shape.
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Computed tomography showed a normal liver (Fig. 1).
The patient's clinical course. Serum HBsAg was negative, and HBV-DNA was present at 2.6 log copies/mL before chemotherapy. Entecavir (ETV) was used during R-THP-COP chemotherapy and the subsequent 14 months. Serum HBV-DNA levels remained undetectable, and serum gammaglobulin levels were within the normal range. ETV was discontinued at 14 months after the end of chemotherapy. However, serum HBV-DNA became positive at 24 months and increased to 3.3 log copies/mL at 27 months. In addition, serum HBsAg also reverted. After restarting ETV at 28 months, serum HBV-DNA and HBsAg immediately turned negative. Anti-HBs became positive for the first time at 31 months and remained positive at 46 months, whereas ETV was re-discontinued at 36 months.
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R-THP-COP therapy [rituximab 375 mg/m2 (610 mg/body), cyclophosphamide 460 mg/m2 (750 mg/body), doxorubicin 30 mg/m2 (50 mg/body), vincristine 0.9 mg/m2 (1.4 mg/body) and prednisolone 1.0 mg/kg (60 mg/body)] with intrathecal administration (methotrexate 10 mg, predonisolone 20 mg and cytarabine 20 mg). R-THP-COP therapy was performed every 4 weeks, 6 times in total, 2 sessions of which were intrathecal administrations (Fig. 2). ETV and was followed up regularly every 1-2 months (Fig. 2). ETV was discontinued at 14 months after the end of chemotherapy because the serum HBsAg, HBV-DNA and hepatitis B core-related antigen (HBcrAg, CLEIA) were all negative. However, his serum HBV-DNA levels became positive at 24 months after the end of chemotherapy (Fig. 2, 3), increasing to 3.3 log copies/mL. HBsAg and HBcrAg also became positive at 27 months after the end of chemotherapy. In addition, anti-HBs became positive for the first time at 31 months after the end of chemotherapy (Fig. 2).
Details of the clinical course from 24 to 29 months after the end of chemotherapy. Serum HBV-DNA became positive at 24 months and increased to 3.3 log copies/mL at 27 months. HBsAg, HBeAg and HBcrAg reverted at the same time. Two weeks later, laboratory data showed a further increase in the serum HBV-DNA levels and reconversion of HBeAg without elevation of serum ALT levels. The patient started taking entecavir (ETV) again at 28 months. After restarting ETV, serum HBV-DNA, HBsAg, HBeAg and HBcrAg immediately turned negative.
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However, his serum HBV-DNA levels became positive at 24 months after the end of chemotherapy (Fig. 2, 3), increasing to 3.3 log copies/mL. HBsAg and HBcrAg also became positive at 27 months after the end of chemotherapy. Two weeks later, laboratory data showed a further increase in the serum levels of HBV-DNA and reconversion of hepatitis B envelope antigen (HBeAg, CLEIA) without elevation of serum alanine aminotransferase (ALT) (Fig. 3). Laboratory data at 28 months after the end of chemotherapy showed normal liver function test findings and further elevations of the HBV-DNA and HBsAg levels (Table and Fig. 3). HBV could not be identified because serum level of HBsAg was very low. He restarted ETV at 28 months after the end of chemotherapy; the serum HBV-DNA, HBsAg, HBeAg and HBcrAg findings immediately turned negative (Fig. 3).