Hepatitis B Virus Reactivation in Lymphoma Patients With Prior Resolved Hepatitis B Undergoing Anticancer Therapy With or Without Rituximab

Abstract

Among HBsAg-negative/anti-HBc-positive DLBCL patients treated with R-CHOP, 25% developed HBV reactivation. Close monitoring until at least 6 months after anticancer therapy is required, with an alternative approach of prophylactic antiviral therapy to prevent this potentially fatal condition.

Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area

“…[18][19][20] Mortalities due to acute exacerbation of HBV in chemotherapy patients therefore occur worldwide. 4,8,24,25 To prevent acute exacerbation of HBV in chemotherapy patients, we developed a novel order entry-based therapeutic control system to increase the prechemotherapy HBV testing rate and improve the HBV prophylactic rate for chemotherapy patients. This study demonstrates that the therapeutic control system achieved a 99.3% HBV screening rate in a hospital, markedly higher than those reported in the literature.…”

“…(HEPATOLOGY 2015;62:387-396) 4 The incidence of HBV reactivation in patients with lymphoma and resolved hepatitis B after rituximab-based therapy ranges from 1.5% to 23.8%. [5][6][7][8] Reactivation of HBV infection in cancer patients receiving chemotherapy may cause interruption of chemotherapy and, in severe cases, lead to liver failure and death. 9-11 Additionally, the prognosis of cancer may be compromised by disruption in anticancer treatment Abbreviations: ALT, alanine aminotransferase; anti-HBc, antibody to hepatitis B core antigen; CI, confidence interval; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCC, hepatocellular carcinoma.…”

“…4 The incidence of HBV reactivation in patients with lymphoma and resolved hepatitis B after rituximab-based therapy ranges from 1.5% to 23.8%. [5][6][7][8] Reactivation of HBV infection in cancer patients receiving chemotherapy may cause interruption of chemotherapy and, in severe cases, lead to liver failure and death. [9][10][11] Additionally, the prognosis of cancer may be compromised by disruption in anticancer treatment during the course of hepatitis, with a delay in treatment cycles and premature termination of chemotherapy.…”

Review article: prevention and management of hepatitis B and C infection in patients with inflammatory bowel disease

“…In these patients, anti-viral prophylaxis is recommended if anti-HBc is detected -even in patients lacking HBsAg -based on reports of severe HBV reactivation in this setting. 74 In any case, liver function and HBV DNA should be periodically monitored in anti-HBc-positive patients with or without anti-HBs during immunosuppressive therapy as occult HBV carriers are more frequent in this group. 1,21 WHICH ANTI-VIRAL PROPHYLAXIS SHOULD BE CHOSEN FOR IBD PATIENTS?…”

HBV treatment in a patient who will be receiving immunosuppressive therapy

“…11 More recently, reverse seroconversion has been reported in patients receiving biologics, and the risk has been found to be particularly high in those treated with rituximab, a monoclonal antibody against CD20 that leads to long-lasting depletion of B cells. 12 In the only prospective study, Yeo et al 12 found that 5 of 21 (24%) HBsAg-negative, anti-HBc-positive patients developed reverse seroconversion during CHOP-R chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab) for diffuse large B cell lymphoma. All five cases caused severe hepatitis, including one death.…”