Hepatitis B Reactivation in Patients With Previous Hepatitis B Virus Exposure Undergoing Rituximab-Containing Chemotherapy for Lymphoma: A Prospective Study

Abstract

A high rate of HBV reactivation was observed in HBsAg-negative, anti-HBc-positive patients undergoing rituximab-containing chemotherapy, with the risk of reactivation significantly higher in anti-HBs-negative patients. Periodic HBV DNA monitoring was an effective strategy in preventing HBV-related complications.

Hepatitis B reactivation in the setting of chemotherapy and immunosuppression - prevention is better than cure

“…As discussed, delayed HBVr has been observed in patients 6-12 mo after completion of chemotherapy (in the absence of antiviral prophylaxis) in both HBsAg positive and HBsAg negative/anti-HBc positive patients, and also when the antiviral prophylaxis has been curtailed to 2 mo post-completion of antiviral therapy [8] . The duration of risk of HBVr appears to be strongly related to the potency of treatment regime, again mentioning that patients who have received B-cell depleting agents appear to be susceptible to delayed HBVr (up to 12 mo post-treatment and beyond) [20] . Hence, antiviral prophylaxis may be required for at least 6 mo after cessation of chemo-or immunosuppressive therapy and for at least 12 mo for those receiving B-cell depleting agents; subsequent monitoring for delayed HBVr after cessation of antiviral prophylaxis is essential.…”

“…Reactivation of HBV has been reported in patients treated for lymphoma, other haematological malignancies and in the setting of haematopoetic stem cell transplant [14,[19][20][21][22] . The prevalence of CHB in patients with lymphoma has been reported as high as 26% [15] .…”

“…HBVr has occurred up to 12 mo after cessation of B-cell depleting drugs (and in a small number of cases delayed beyond 12 mo) indicating the potency of the immunosuppressive effect of this drug class and the prolonged immune reconstitution phase. A study of 63 HBsAg negative/antiHBc positive patients with haematological malignancy who received rituximab without antiviral prophylaxis has been reported [20] . At 2 years, 41.5% had experienced HBVr which occurred at a median of 23 (range 4-100) wk after rituximab treatment [20] .…”

“…A study of 63 HBsAg negative/antiHBc positive patients with haematological malignancy who received rituximab without antiviral prophylaxis has been reported [20] . At 2 years, 41.5% had experienced HBVr which occurred at a median of 23 (range 4-100) wk after rituximab treatment [20] . These observations would indicate that any monitoring or antiviral prophylaxis prescribed to these patients may require longer duration than other classes of immunosuppressive drugs.…”

HBsAg loss in chronic hepatitis B: pointers to the benefits of curative therapy

“…It is recognised that intrahepatic HBV genomes may persist in HBsAg-negative individuals: both covalently closed circular (ccc) DNA and integrated hepatitis B viral genomes may persist in the liver after HBsAg clearance from serum [10]. Consequently, reactivation may occur either spontaneously, and importantly, after chemotherapy in patients with hematological and solid malignancies, or after immunosuppression in HBsAg negative, anti-HBc positive persons [11].…”