In patients with
non-Hodgkin's lymphoma (NHL), there are some well-known
tumor-related adverse prognostic factors that may increase the mortality rate. However, secondary factors such as viral
hepatitis carriers that may decrease the cure rates are usually ignored. Reactivation of hepatitis B virus (HBV)
infection in patients undergoing cytotoxic treatment for NHL is a well-known complication. Charts of 112 patients with NHL were retrospectively analyzed regarding their
hepatitis serology, the indirect effects of seropositivity on disease outcome, and the precautions undertaken in these seropositive patients with NHL. Twelve patients (11%) with
HBsAg positivity and two patients (1.7%) with antibody to hepatitis C virus positivity were detected. Eight out of 12 patients (67%) with
HBsAg positivity and two patients (50%) with anti-HCV positivity showed reactivation of
hepatitis during treatment of NHL. No reactivation was detected in four patients seropositive for HBV, who were given
lamivudine prophylaxis before the initiation of
chemotherapy schedules. Among patients with
hepatitis reactivation, two were treated with
lamivudine resulting in dramatic improvement and clinical remission of the disease. The remaining six patients with reactivation were left untreated, resulting in four deaths (67%) due to
liver failure secondary to HBV and two deaths secondary to
delayed treatment of NHL. One patient seropositive for anti-HCV also developed
chronic hepatitis C. Determination of
hepatitis serology in all patients with NHL before any
chemotherapy administration is crucial, but insufficient, if not taken into consideration. In seropositive patients, HBV
DNA should be determined and
antiviral prophylaxis with
lamivudine should be initiated before any treatment.