Prophylaxis against hepatitis B reactivation among patients with lymphoma receiving rituximab

Abstract

Hepatitis B virus (HBV) reactivation occurs commonly in patients with non-Hodgkin lymphoma, receiving rituximab-based therapeutic regimen. Guidelines from different organizations are not all in agreement with regard to screening and antiviral prophylaxis, given the limited evidence. Antiviral prophylaxis has been recommended for all HBV surface antigen-positive patients. Evidence for benefit from prophylaxis has recently been recognized among HBV surface antigen-negative/HBV core antibody-positive patients. Incidence of HBV reactivation varies in different geographical locations and the decision to start antiviral prophylaxis should consider local incidence data. Given the increased rates of rituximab-associated HBV reactivation and potentially fatal outcome, it is prudent that all patients who receive rituximab should be screened for HBV markers.

Chronic lymphocytic leukaemia

“…Patients also should be treated with prophylactic antibiotics to mitigate the risk for opportunistic infection, such as that caused by Pneumocystis jiroveci . Finally, as with any patient receiving therapy with anti-CD20 monoclonal antibodies, patients should be screened for active infection with hepatitis B virus before the initiation of therapy 155 , and periodically monitored for reactivation of cytomegalovirus, especially if they should develop unexplained symptoms of infection.…”

Antiviral prophylaxis in patients with solid tumours and haematological malignancies—update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO)

“…Additionally, all patients receiving B-cell antibodies should be screened for chronic hepatitis B as a clinical standard [ 44 ]. This recommendation has been expressed in guidelines of different societies [ 45 – 52 ].…”

“…Administration of anthracyclines is a negative prognostic factor in these patients [ 26 , 27 ]. On the other hand, HBV reactivation occurs in 30–50 % of patients with malignant lymphoma [ 86 ], with even higher rates during treatment with rituximab [ 40 , 44 ]…”

Improvements in hepatitis B virus screening before rituximab therapy: A community‐based, safety‐net hospital experience

“…8,10 Although the presence of positive HBsAg status carries a more significant risk, the risk of reactivation in those who are positive for HBcAb is also significant enough to warrant attention; a recent meta-analysis demonstrated that HBsAg-negative/HBcAb-positive patients who were receiving RTX therapy for non-Hodgkin lymphoma were >5 times more likely to experience HBV reactivation. 12 In such patients who are receiving high-risk therapies, studies have established the efficacy of administering antiviral treatments, such as lamivudine, 8,13 tenfovoir, 14 and entecavir, 15 prophylactically to prevent HBV-associated complications. 12 In such patients who are receiving high-risk therapies, studies have established the efficacy of administering antiviral treatments, such as lamivudine, 8,13 tenfovoir, 14 and entecavir, 15 prophylactically to prevent HBV-associated complications.…”

“…6 Retrospective studies have confirmed that the rate of HBV reactivation varies between 2.7% and 23.8% in HBcAbpositive patients, 11 and a recent prospective study in an HBV-endemic area (Taiwan) demonstrated an HBV reactivation incidence of 17.9% among HBsAg-negative/ HBcAb-positive patients. 12 In such patients who are receiving high-risk therapies, studies have established the efficacy of administering antiviral treatments, such as lamivudine, 8,13 tenfovoir, 14 and entecavir, 15 prophylactically to prevent HBV-associated complications.…”