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

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Source: Ann Hematol | Posted 3 days ago

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 YX, Tay M, Teh YE, Teng D, Tan DS, Tan IB, Tai DW, Quek R, Tao M, Lim ST;

ls of Hematology (Apr 2011)

The use of rituximab has been associated with increased risk of hepatitis B

virus (HBV) reactivation in patients who are hepatitis B surface antigen (HBsAg)

negative and antihepatitis B core antibody (anti-HBc) positive. We aim to

determine the rate of HBV reactivation in this group of patients who received

rituximab-containing combination chemotherapy without concomitant antiviral

prophylaxis and to identify potential risk factors for reactivation. Sixty-two

HBsAg negative/anti-HBc positive patients with B-cell lymphoma treated with

rituximab-based immunochemotherapy from 2006 to 2009 were included. None of the

patients received concomitant antiviral prophylaxis. In this cohort, 48 (77%)

patients received rituximab with cyclophosphamide, doxorubicin, vincristine, and

prednisone (R-CHOP), eight (13%) received rituximab with cyclophosphamide,

vincristine and prednisolone, and six (10%) received other chemotherapy

regimens. Two patients suffered HBV reactivation; both were above 70 years of

age, received R-CHOP chemotherapy and were negative for antihepatitis B surface

antibody (anti-HBs) at baseline. One of the two patients reactivated shortly

after completion of R-CHOP chemotherapy while the other reactivated during

rituximab maintenance treatment. Thus, the overall reactivation rate in this

cohort of patients is 3% (2/62), 4% (2/48), and 25% (1/4) in patients who

received R-CHOP chemotherapy and who received rituximab maintenance,

respectively. The rate of HBV reactivation is low in patients who are HBsAg

negative/anti-HBc positive receiving rituximab-based combination chemotherapy

without concomitant antiviral prophylaxis. However, elderly patients,

particularly those without anti-HBs, seemed particularly at risk.