自家末梢血幹細胞移植から24カ月後に発症した de novo B 型肝炎の1例  [in Japanese] A case of de novo hepatitis B developed after 24 months later from autologous peripheral blood cell transplantation  [in Japanese]

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Abstract

症例は60歳代男性.多発性骨髄腫に対して2度の自家末梢血幹細胞移植を含む大量化学療法を施行,その後寛解を維持していた.2度目の移植から約24カ月後に著明な肝障害が出現した.当初はHBV感染症との認識はなかったが,過去の保存血清よりHBV既感染と判明し,de novo B型肝炎と診断した.主にリツキシマブとステロイド併用の化学療法によるHBV再活性化について,2009年に厚生労働省からガイドラインが発表された.末梢血幹細胞移植後のHBV再活性化はそれらと比較して発症が遅いと報告され,病態も異なる.本症例は移植から約24カ月後に免疫抑制剤の投与なく肝炎を発症した.末梢血幹細胞移植後のde novo B型肝炎の発症予防には更に長期のモニタリングが必要であり,今後管理体制の確立が求められる.

A 60-year-old man received high dose chemotherapy twice including autologous peripheral blood stem cell transplantation for multiple myeloma, and complete remission was sustained. Severe hepatic injury revealed after 24 months later from last treatment. We didn't recognized initially, our examination of conserved serum revealed he was already infected hepatitis B. So we diagnosed that he suffered de novo hepatitis B, and administered entecavir immediately. Generally de novo hepatitis B was easily shifted to fulminant hepatitis and mortality rate was very high. We recommended careful and long-term observation after autologous peripheral blood stem cell transplantation.

Journal

Kanzo  

Kanzo 52(9), 602-606, 2011-09-25 

The Japan Society of Hepatology

References:  14

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Codes

  • NII Article ID (NAID) :
    10029688165
  • NII NACSIS-CAT ID (NCID) :
    AN00047770
  • Text Lang :
    JPN
  • Article Type :
    NOT
  • ISSN :
    04514203
  • NDL Article ID :
    11248694
  • NDL Source Classification :
    ZS21(科学技術--医学--内科学)
  • NDL Call No. :
    Z19-130
  • Databases :
    CJP  NDL  J-STAGE