Hepatitis B virus reactivation in B-cell lymphoma patients treated with rituximab: Analysis from the Asia Lymphoma Study Group

Kim, Seok Jin; Hsu, Chiun; Song, Yinggai; Tay, Kevin; Hong, Xin; Cao, Junning; Kim, Jin Seok; Eom, Hyeon Seok; Lee, Joon Hyeok; Zhu, Jun; Chang, Kian Meng; Reksodiputro, Arry Harryanto; Tan, Daryl; Goh, Yeow Tee; Lee, Je‐Jung; Intragumtornchai, Tanin; Chng, Wee Joo; Cheng, Ann‐Lii; Lim, Soon Thye; Suh, Cheolwon; Kwong, Yok Lam; Kim, Won Seog

doi:10.1016/j.ejca.2013.07.006

Cited by 121 publications

(111 citation statements)

References 32 publications

Supporting

Mentioning

106

Contrasting

Unclassified

Order By: Relevance

“…Kim et al recently reported that no HBV reactivation was observed in 31 HBsAg-positive patients who received entecavir, whereas 30 of 96 (31%) who received lamivudine developed HBV reactivation after R-CHOP-like regimens. 24 Although the current evidence regarding prevention of HBV reactivation is insufficient for a definitive recommendation, it would seem that entecavir or tenofovir is better option as a first-line antiviral drug in view of the higher efficacy and less development of resistance. 28 How long should we continue antiviral prophylaxis after anti-B-cell therapy?…”

Section: Strategy To Prevent Hbv Reactivation In Hbsag-positive Patientsmentioning

confidence: 99%

“…26 More recently, Kim et al conducted a multinational retrospective study to evaluate the incidence of HBV reactivation and its risk factors and found that 13 of 22 (59%) HBsAg-positive patients had HBV reactivation without antiviral prophylaxis. 24 …”

Section: Risk Of Hbv Reactivation After Immunosuppressive Therapymentioning

confidence: 99%

“…In 2013, Kim et al also showed that 16 of 153 (10%) HBsAg-negative but anti-HBc-positive patients developed HBV reactivation after R-CHOP in a multinational retrospective analysis. 24 …”

Section: Hbv Reactivation In Hbsag-negative Patients (With Resolved Hmentioning

confidence: 99%

“…21 The rituximab ϩ steroid-containing chemotherapy has recently been demonstrated to be a risk factor for HBV reactivation in HBsAgnegative patients, 5,6 HBV reactivation is a well-known complication after allogeneic hematopoietic stem cell transplantation (HSCT) because of the long-term use of immunosuppressive drugs and the gradual immune reconstitution after HSCT. 22,23 Additional host risk factors for HBV reactivation have been reported as male sex, 6 diagnosis of lymphoma, 3 absence of anti-HBs at baseline, 6,24 and decrease of anti-HBs titers after immunosuppressive therapy. 25 The risk classification for HBV reactivation according to serum HBV markers and the intensity of immunosuppressive therapy can be determined based on the current evidence ( Figure 1).…”

Section: Risk Of Hbv Reactivation After Immunosuppressive Therapymentioning

confidence: 99%

“…7,28,29 The incidence of HBV reactivation in HBsAg-positive patients receiving rituximabcontaining chemotherapy without antiviral prophylaxis has been reported to be 59%-80%. 24,26 These patients are considered to constitute a very-high-risk group for HBV reactivation (Figure 1). Of the HBsAg-positive patients, most HBV reactivation occurs during and after chemotherapy, but patients with high HBV DNA levels at baseline potentially suffer HBV reactivation at an early stage of chemotherapy.…”

Section: Strategy To Prevent Hbv Reactivation In Hbsag-positive Patientsmentioning

confidence: 99%

See 4 more Smart Citations

Screening for and management of hepatitis B virus reactivation in patients treated with anti-B-cell therapy

Kusumoto

Tobinai

2014

Hematology

View full text Add to dashboard Cite

Reactivation of hepatitis B virus (HBV) is a potentially fatal complication after anti-B-cell therapy. It can develop not only in patients seropositive for hepatitis B surface antigen (HBsAg), but also in those with resolved HBV infection who are seronegative for HBsAg but seropositive for antibodies against hepatitis B core antigen (anti-HBc) and/or antibodies against HBsAg (anti-HBs). The risk of HBV reactivation depends on the balance between replication of the virus and the immune response of the host. Anti-CD20 monoclonal antibody-rituximab in combination with steroid-containing chemotherapy (R-CHOP: rituximab ϩ cyclophosphamide ϩ hydroxydaunorubicin ϩ vincristine ϩ prednisone/prednisolone)-is an important risk factor for HBV reactivation in HBsAg-negative patients. More obviously, HBsAg-positive patients are considered to be at very high risk for HBV reactivation and, in the rituximab era, 59%-80% of these patients develop HBV reactivation after R-CHOP-like chemotherapy. Patients with resolved HBV infection should also be considered at high risk of HBV reactivation, the incidence of which is reported to be 9%-24% in such lymphoma patients. All patients should be screened to identify risk groups for HBV reactivation before initiating anti-B-cell therapy by measuring serum HBV markers including HBsAg, anti-HBc and anti-HBs. To prevent the development of hepatitis due to HBV reactivation after anti-B-cell therapy, antiviral prophylaxis is recommended for HBsAg-positive patients and/or patients in whom HBV DNA is detectable at baseline, whereas regular monitoring of HBV DNA-guided preemptive antiviral therapy is a reasonable and useful approach for patients with resolved HBV infection. Learning Objectives• To become familiar with the risk of HBV reactivation in patients who receive anti-B-cell therapy • To manage such high-risk patients successfully using antiviral prophylaxis or by HBV DNA-monitoring-guided preemptive antiviral therapy

show abstract

Section: Strategy To Prevent Hbv Reactivation In Hbsag-positive Patientsmentioning

confidence: 99%

Section: Risk Of Hbv Reactivation After Immunosuppressive Therapymentioning

confidence: 99%

“…In 2013, Kim et al also showed that 16 of 153 (10%) HBsAg-negative but anti-HBc-positive patients developed HBV reactivation after R-CHOP in a multinational retrospective analysis. 24 …”

Section: Hbv Reactivation In Hbsag-negative Patients (With Resolved Hmentioning

confidence: 99%

Section: Risk Of Hbv Reactivation After Immunosuppressive Therapymentioning

confidence: 99%

Section: Strategy To Prevent Hbv Reactivation In Hbsag-positive Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Screening for and management of hepatitis B virus reactivation in patients treated with anti-B-cell therapy

Kusumoto

Tobinai

2014

Hematology

View full text Add to dashboard Cite

show abstract

Optimal Antiviral Prophylaxis Against Hepatitis B Reactivation in Patients Receiving Rituximab-Based Chemotherapy for Lymphoma

Abramson

Chung

2014

JAMA

View full text Add to dashboard Cite

Medical interventions associated with HBV reactivation: Common and less common

Reynolds

Manch

Gish

2015

Clinical Liver Disease

View full text Add to dashboard Cite

Hepatitis due to hepatitis B virus (HBV) reactivation is a potentially serious cause of liver injury that may be induced by immunosuppressive drugs and treatments. Liver damage occurs as a result of impaired immune control over viral replication, which often results in a hepatitis flare. These flares can be significant and lead to jaundice, liver failure, and death. The incidence of HBV reactivation is poorly defined, which is due in part to the lack of standardized nomenclature and definitions of what constitutes HBV reactivation. A recent consensus conference has now proposed criteria for HBV reactivation and exacerbation. Efforts are currently underway to standardize definitions that may help guide future studies and recommendations. 1 Many factors contribute to HBV reactivation, including host characteristics, baseline hepatitis B e-antigen status, and the level of HBV DNA at baseline. The immunosuppressant or treatment received also plays a large role in the development of HBV reactivation. As immunosuppressive agents are used more widely across a variety of medical fields, drug-induced HBV reactivation will become a more common clinical entity facing a broader range of medical personnel. Early recognition of patients at risk for HBV reactivation and initiation of antiviral prophylaxis will undoubtedly prevent many cases of liver injury and death. The major classes of immunosuppressive agents, and their risks of HBV reactivation, will be discussed further below (Table 1). CorticosteroidsCorticosteroids such as prednisone are commonly used medications and a mainstay of many chemotherapeutic regimens. They have also been shown to increase the risk of HBV reactivation in many patient populations when used alone, and particularly when given in combination with another immunosuppressant. This reactivation of HBV replication is thought to be mediated by suppression of cytotoxic T-cell function and direct stimulation of a glucocorticoid-responsive element within the HBV genomic sequence. In one study of HBsAg-positive patients exposed to long-term prednisolone (10 mg) versus placebo, there was earlier viral relapse after steroid discontinuation; delay in biochemical remission; and an increased frequency of complications, including death. 2 In a separate randomized controlled study of corticosteroid use in patients undergoing CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) for lymphoma versus the same regimen without steroids, HBV reactivation was seen in 73% of patients versus 38% in the group who did not receive corticosteroids (P 5 0.03). 3 Thus, corticosteroid use for both short-term and long-term duration is an independent and additive risk factor of HBV reactivation in HBsAg-positive patients. The effect of corticosteroids in patients who are HBsAg-negative and anti-hepatitis B core (HBc)-positive, however, is not well characterized. AntimetabolitesAzathioprine or 6-mercaptopurine, when used as monotherapy, appears to have very little risk of HBV reactivation. Most prior studies implying a r...

show abstract

Hepatitis B virus reactivation in B-cell lymphoma patients treated with rituximab: Analysis from the Asia Lymphoma Study Group

Cited by 121 publications

References 32 publications

Screening for and management of hepatitis B virus reactivation in patients treated with anti-B-cell therapy

Screening for and management of hepatitis B virus reactivation in patients treated with anti-B-cell therapy

Optimal Antiviral Prophylaxis Against Hepatitis B Reactivation in Patients Receiving Rituximab-Based Chemotherapy for Lymphoma

Medical interventions associated with HBV reactivation: Common and less common

Contact Info

Product

Resources

About