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Reactivation of hepatitis B virus infection following ruxolitinib treatment in a patient with myelofibrosis

Leukemia volume 28, pages 225–227 (2014)Cite this article

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The widespread use of molecularly targeted drugs with immunosuppressive or immunomodulating action has increased the risk of hepatitis B virus (HBV) reactivation, which may clinically vary from an asymptomatic condition to severe hepatitis and even fatal hepatic failure.1 HBV is not directly cytopathogenic and liver injury is mainly mediated by the host immune system. Long-lasting immune surveillance by specific host T-lymphocytes against HBV epitopes is thought to be a major cause of long-term viral suppression.2 Monoclonal antibodies such as the anti-CD20 rituximab, used for treatment of B-cell non-Hodkgin’s lymphoma, or the anti-CD52 alemtuzumab, a therapeutic option in chronic lymphatic leukemia, but also tumor necrosis factor-alpha (TNF-α) inhibitors, well known for their role in mediating inflammatory and immune responses, determine long-lasting immunosuppression and can potentially cause HBV reactivation.3 However, the pathogenesis of HBV reactivation during immunosuppressive therapy or chemotherapy is yet to be fully understood.

Ruxolitinib is a novel inhibitor of Janus-activated kinases 1 and 2 (JAK1 and JAK2) that has recently been approved for the treatment of patients with myelofibrosis (MF). Clinical trials have shown that ruxolitinib can effectively reduce the size of the spleen and liver and improve MF-related symptoms.4 MF is a myeloproliferative disease characterized by excessive production of reticulin and collagen fibers, hepatosplenomegaly and anemia. About 50% of patients present the JAK2V617F mutation, resulting in a constitutively activated JAK signal and increased production of cytokines. This is the first case describing HBV reactivation following ruxolitinib treatment in a patient with MF.

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Authors and Affiliations

  1. Department of Medical Sciences, Hematology Unit, University of Cagliari, Cagliari, Italy

    G Caocci, F Murgia, S Atzeni & G La Nasa

  2. Bone Marrow Transplant Center, R. Binaghi Hospital, Cagliari, Italy

    G Caocci & G La Nasa

  3. Hematology Unit, University Hospital, Sassari, Italy

    L Podda

  4. Department of Biomedical Science, University of Sassari, Sassari, Italy

    A Solinas

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  1. G Caocci
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Correspondence to G Caocci.

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Caocci, G., Murgia, F., Podda, L. et al. Reactivation of hepatitis B virus infection following ruxolitinib treatment in a patient with myelofibrosis. Leukemia 28, 225–227 (2014). https://doi.org/10.1038/leu.2013.235

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