Management of hepatitis B reactivation in lymphoma patients on rituximab with past hepatitis B exposure: An observational study

Abstract

Background Currently, a standardized approach to prevent and manage hepatitis B reactivation in lymphoma patients with past hepatitis exposure receiving rituximab in Singapore is lacking. This study is designed to report the current management approach and outcomes associated with hepatitis B reactivation. Objectives The primary objective was to report 6-, 12-, 24-month cumulative hepatitis B reactivation-related outcomes. Secondary objectives were to report monitoring frequencies of hepatitis B DNA and liver function tests performed in lymphoma patients with resolved hepatitis B receiving rituximab, and anti-viral prophylaxis use. Methodology This was a single centre, retrospective observational study. Patients with resolved hepatitis B initiated on rituximab from January 2011 to December 2015 were identified and reviewed over a two-year period starting from the date of rituximab initiation. Relevant parameters were obtained from electronic medical records. Hepatitis B reactivation was defined by hepatitis B DNA levels 20 IU/ml (1.30 log/ml) and above. Data were analysed using descriptive statistics. Results Seventy-five patients were retrospectively reviewed over a two-year period. Hepatitis B reactivation was defined as hepatitis B DNA levels ≥20 IU/ml (1.30 log/ml). The 24-month cumulative hepatitis B reactivation rate was 4.0%. The median (interquartile range) number of hepatitis B DNA tests performed during treatment, initial six-month follow-up, and subsequent follow-up were 1.0 (0.0-2.6), 1.0 (0.0-2.0), and 1.0 (0.0-3.1), respectively. Conclusion Large variations in hepatitis B reactivation monitoring and management strategies were observed. Further studies are required to develop and determine a standardised protocol that could contribute to safer and more cost-effective care for lymphoma patients with resolved hepatitis B on rituximab.

Real-world prevalence of hepatitis B virus reactivation in cancer patients in Taiwan

“…This patient experienced HBV reactivation between consecutive cycles without any prophylaxis and then HBV DNA increased dramatically. Our findings on the higher risk chemotherapy regimens are aligned with the findings from studies published in Taiwan 7,17 and from US FDA data analysis report, 6 but no statistically significant differences were found among all combinations between HBV reactivation and nonreactivation groups.…”

“…A report published in 2018 presented that physicians used lamivudine as the prophylactic oral agent in southern Taiwan. 17 In the previous study, the lamivudine as prophylaxis drug decreases HBV reactivation rate HBV-related hepatitis and severe events. 30 In another study that included HBsAg seropositive patients with breast cancer who were undergoing chemotherapy, the incidences of HBV reactivation, HBV-related hepatitis, and severe events were lower than in the patients who received lamivudine prophylaxis as compared to those who did not receive prophylaxis (0% vs. 28.6%).…”

“…14 Similarly, Yeo et al found that the 24-month cumulative HBV reactivation rate was as low as 4.0%. 15 Liu et al reported that lymphoma patients receiving rituximab taking prophylactic entecavir had no HBV reactivation or related hepatitis. 16 The issue of chemotherapy-induced HBV reactivation has gained attention in Taiwan in recent years.…”

“…examined patients with resolved HBV infection in all types of cancers in southern Taiwan. 7,17 Given that Taiwan is a HBV epidemic area, it is essential to engage in the discussion of chemotherapy-induced HBV reactivation by analyzing cases from different region of Taiwan in order to advance the understanding of the issue. Therefore, the present study analyzed the prevalence of HBV reactivation among patients in all types of cancers in central Taiwan.…”

Pharmacotherapy-Induced Hepatitis B Reactivation Among Patients With Prior Functional Cure: A Systematic Review

“…A total of 37 studies including 3601 patients with resolved HBV infection evaluated the use of rituximab for hematological malignancies or solid tumors, generally in addition to other cytotoxic chemotherapeutic agents (Table 2). 8,9,18-52 In most of the studies, patients did not receive prophylaxis. The incidence of HBVr ranged from 0% to 30.2%, with an overall rate of 6.2% (225/3601).…”