Ann Surg Treat Res.  2018 Apr;94(4):216-218. 10.4174/astr.2018.94.4.216.

Living donor liver transplantation prior to multiple myeloma treatment in a patient with hepatitis B-associated hepatocellular carcinoma and liver cirrhosis: a case report

• Cho CW
• Lee N
• Choi GS
• Kim JM
• Kwon CH
• Joh JW

• KMID: 2407752
• DOI: http://doi.org/10.4174/astr.2018.94.4.216

Abstract

Clinical outcomes of living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) in patients with multiple myeloma (MM) have not been established in terms of HCC recurrence and MM deterioration after LDLT. A 51-year-old man with chronic hepatitis B was diagnosed with HCC and MM. Since the patient also had decompensated liver cirrhosis (LC), he underwent LDLT prior to autologous peripheral blood stem cell transplantation (PBSCT) to prevent fulminant hepatitis due to HBV reactivation. The patient received Epstein-Barr virus prophylaxis and a triple immunosuppressive regimen of tacrolimus, everolimus, and steroid after LDLT. Autologous PBSCT was performed 7 months after LDLT. He showed a complete response to treatment of MM without post-LT complications or HCC recurrence. In conclusion, LDLT could be adapted for treatment of MM patients with combined HCC and decompensated LC because it is an effective strategy of preventing HBV reactivation and HCC recurrence after induction therapy of MM.

Keyword

Living donor liver transplantation; Multiple myeloma; Hepatocellular carcinoma

MeSH Terms

Carcinoma, Hepatocellular*
Everolimus
Hepatitis B, Chronic
Hepatitis*
Herpesvirus 4, Human
Humans
Liver Cirrhosis*
Liver Transplantation*
Liver*
Living Donors*
Middle Aged
Multiple Myeloma*
Peripheral Blood Stem Cell Transplantation
Recurrence
Tacrolimus
Everolimus
Tacrolimus

Figure

• 

  Fig. 1 Bone marrow aspiration (×400): plasma cell proliferation at the time of diagnosis (A), absence of residual plasma cells after autologous peripheral blood stem cell transplantation (B).

Reference

1. Bhandari MS, Mazumder A, Vesole DH. Liver involvement in multiple myeloma. Clin Lymphoma Myeloma. 2007; 7:538–540.

2. Huang B, Li J, Zhou Z, Zheng D, Liu J, Chen M. High prevalence of hepatitis B virus infection in multiple myeloma. Leuk Lymphoma. 2012; 53:270–274.

3. Sadeghian MH, Ayatollahi H, Keramati MR, Memar B, Jamedar SA, Avval MM, et al. The association of Epstein-Barr virus infection with multiple myeloma. Indian J Pathol Microbiol. 2011; 54:720–724.

4. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Français du Myelome. N Engl J Med. 1996; 335:91–97.

5. Zhang Y, Zhao H, He X, Zheng S, Wang T, Yan D, et al. Effects of Epstein-Barr virus infection on the development of multiple myeloma after liver transplantation. Sci China Life Sci. 2012; 55:735–743.

6. Bandi P, Garcia ML, Booth CJ, Chisari FV, Robek MD. Bortezomib inhibits hepatitis B virus replication in transgenic mice. Antimicrob Agents Chemother. 2010; 54:749–756.

7. Yeo W, Johnson PJ. Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology. 2006; 43:209–220.

8. Cholongitas E, Mamou C, Rodriguez-Castro KI, Burra P. Mammalian target of rapamycin inhibitors are associated with lower rates of hepatocellular carcinoma recurrence after liver transplantation: a systematic review. Transpl Int. 2014; 27:1039–1049.

9. Holdaas H, De Simone P, Zuckermann A. Everolimus and malignancy after solid organ transplantation: a clinical update. J Transplant. 2016; 2016:4369574.

10. Gunther A, Baumann P, Burger R, Kellner C, Klapper W, Schmidmaier R, et al. Activity of everolimus (RAD001) in relapsed and/or refractory multiple myeloma: a phase I study. Haematologica. 2015; 100:541–547.