Autologous bone marrow transplantation for recurrent malignant lymphoma after liver transplantation

Background. Cancer chemotherapy in chronic carriers of hepatitis B virus is known to promote viral replication, and, when immunosuppressive treatment is stopped, the return of immune competence can be followed by a fulminant hepatitis. Liver transplantation may be required and has been successfully performed for this condition. However, malignancy recurrence after transpla ntation has not been reported yet. Methods and Results. We here report the case of an asymptomatic hepatitis B surface antigen carrier who developed a malignant lymphoma, which was trea ted by chemotherapy. After cessation of chemotherapy, he developed a fulmin ant hepatitis, requiring liver transplantation. Three years later, he devel oped a recurrent malignant lymphoma, which was treated successfully by auto logous bone marrow transplantation. In order to prevent viral replication, lamivudine and intermittent administration of fresh-frozen plasma highly co ncentrated in anti-HBs immunoglobulin was initiated before the bone marrow transplantation. The patient remains well 12 and 56 months after autologous bone marrow and liver transplantation, respectively. Conclusions. This experience suggests that ail hepatitis B surface antigen- positive patients for whom chemotherapy is indicated would benefit from pro phylactic antiviral hepatitis B virus therapy. Furthermore, successful auto logous bone marrow transplantation is possible after liver transplantation.