Risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen negative/hepatitis B core antibody positive patients receiving rituximab-containing combination chemotherapy without routine antiviral prophylaxis

Koo, Yu Xuan; Tay, Matthew Zirui; Teh, Yii Ean; Teng, David; Tan, Daniel S.W.; Tan, Iain Bh; Tai, David; Quek, Richard; Tao, Miriam; Lim, Soon Thye

doi:10.1007/s00277-011-1241-0

Cited by 98 publications

(75 citation statements)

References 14 publications

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“…In another Asian study only one (2.3%) of 43 DLBCL patients treated with an R-CHOP regimen showed reactivation of HBV replication [73] , for which a remission was obtained with antiviral therapy with no need to discontinue chemotherapy. Koo et al [74] described HBV reactivation in two (3%) of 62 HBsAg-negative/ anti-HBc-positive patients treated with rituximab-based chemotherapy who did not undergo anti-HBV prophylaxis. More recently, the Asia Lymphoma Study Group investigated for HBV reactivation HBsAg-positive patients and HBsAg-negative/HBcAb-positive patients who received rituximab-based chemotherapy; the study was retrospective and performed on 340 patients, with a reactivation rate of 2.4% in subjects with OBI and 27.8% in HBsAg-positive patients [75] .…”

Section: Hematological Diseasesmentioning

confidence: 99%

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

Sagnelli

Pisaturo

Martini

et al. 2014

WJH

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Section: Hematological Diseasesmentioning

confidence: 99%

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

Sagnelli

Pisaturo

Martini

et al. 2014

WJH

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“…On the other hand, the prophylactic administration of an antiviral drug before chemotherapy in HBsAg-negative patients with HBcAb and/or HBsAb positivity is not recommended for economic reasons (48). (26,36) Male sex (13,27) Use of anthracyclines (12,36,41) Cancer type: malignant lymphoma (12,36) Use of rituximab (6,7,(32)(33)(34)42) Cancer type: breast cancer (36,37) Cancer type: liver cancer (22,24) High HBV DNA level (36)(37)(38) HBeAg seropositive (12,22,24) High intrahepatic covalently closed circular DNA (cccDNA) (39) Low titer of HBsAb (31,40) Elevated serum ALT level (25) Figure 2. Pattern of hepatitis B viral reactivation in a hepatitis B surface antigen (HBsAg)-negative patient with hepatitis B core antibody (HBcAb) and/or hepatitis B surface antibody (HBsAb) positivity (7).…”

Section: Hbsag-negative Patients With Hbcab And/or Hbsab Positivitymentioning

confidence: 99%

Reactivation of Hepatitis B Virus in Patients Receiving Chemotherapy

Ikeda

2012

Japanese Journal of Clinical Oncology

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In patients undergoing chemotherapy for the treatment of malignant disease, the reactivation of hepatitis B virus in hepatitis B surface antigen-positive patients has been frequently reported. However, activation has also been reported in hepatitis B surface antigen-negative patients who test positive for hepatitis B core antibody and/or hepatitis B surface antibody, who were thought to have had transient infections and to have been cured. Reactivation has often been reported in patients receiving rituximab-containing regimens and has attracted a lot of attention in recent years. In Japan, 1 -3% of patients undergoing chemotherapy are hepatitis B surface antigen-positive, and 20 -25% of patients are hepatitis B surface antigen-negative with hepatitis B core antibody and/or hepatitis B surface antibody positivity; therefore, about one out of every four patients undergoing chemotherapy may be at risk for the reactivation of hepatitis B virus. In most of the guidelines for hepatitis B virus reactivation, the prophylactic administration of an antiviral drug in hepatitis B surface antigen-positive patients is recommended, and periodic monitoring of hepatitis B virus DNA and the deferred pre-emptive administration of an antiviral drug after conversion to hepatitis B virus DNA positivity are recommended in hepatitis B surface antigen-negative patients who are hepatitis B core antibody-positive and/or hepatitis B surface antibody-positive when chemotherapy has been scheduled. However, numerous issues regarding hepatitis B virus reactivation, including the frequency, the types of anticancer drugs, the cancers that facilitate hepatitis B virus reactivation and the optimal method of management, etc., have not been fully clarified. A variety of well-designed prospective studies are currently under way in both Japan and abroad, and strong evidence of hepatitis B virus reactivation following chemotherapy is anticipated in the future.

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“…The risk appears to be higher in older patients and patients without antibodies to hepatitis B surface antigen (anti-HBs). 13 Anti-HBs titers may decline or even disappear during chemotherapy, and there is some evidence that this is associated with an increased risk of reactivation; however, the data are limited. Patients with detectable HBV DNA are at particularly high risk and should probably receive preemptive antiviral therapy.…”

Section: Management Of Anti-hbc-positive Patientsmentioning

confidence: 99%

“…Other retrospective studies have reported lower rates of reverse seroconversion with rituximab-based chemotherapy, and uncertainty remains regarding the true risk associated with this agent. 13,14 Given the high prevalence of anti-HBc positivity, particularly in HBV-endemic regions, and the increasing use of rituximab for many conditions, clarifying the risk and appropriate management strategy for patients receiving rituximab needs to be a priority.…”

Section: Reverse Seroconversionmentioning

confidence: 99%

HBV treatment in a patient who will be receiving immunosuppressive therapy

Feld

2013

Clinical Liver Disease

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Despite an effective vaccine, hepatitis B virus (HBV) infection remains an enormous global public health problem with up to 400 million people chronically infected and as many as 2 billion people with evidence of exposure to the virus worldwide. 1,2 The virus is noncytopathic, with hepatic injury occurring as a result of the host immune response against the virus. 1 As a result, the interaction between HBV and the immune system is critical in determining the outcome of infection.After perinatal or early childhood infection, >90% of individuals will progress to chronic infection, initially characterized by normal liver tests and histology despite high levels of HBV replication, the so-called immunotolerant phase of infection. 2 Patients eventually develop an immune response against HBV, leading to flares of hepatitis with the potential for progressive liver damage. Ultimately, most immunocompetent patients will gain immune control of HBV, with suppression of viral replication, normalization of liver enzymes, and loss of circulating HBeAg. 2 Persistence of this inactive carrier state depends on immune function. Even those with undetectable HBV DNA in the serum continue to harbor replication-competent HBV in infected liver cells. With immunosuppression, immune control may be lost, resulting in reactivation of HBV replication with the potential for severe flares of hepatitis, often at the time of restoration of immune function. Reactivation has variable clinical consequences ranging from asymptomatic increases in serum HBV DNA to potentially fulminant and even fatal flares of hepatitis. 3,4 Reactivation may also lead to interruptions or premature discontinuation of immunosuppressive therapy, including cancer chemotherapy with potential negative consequences. 5

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Risk of hepatitis B virus (HBV) reactivation in hepatitis B surface antigen negative/hepatitis B core antibody positive patients receiving rituximab-containing combination chemotherapy without routine antiviral prophylaxis

Cited by 98 publications

References 14 publications

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

Reactivation of Hepatitis B Virus in Patients Receiving Chemotherapy

HBV treatment in a patient who will be receiving immunosuppressive therapy

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