Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-based chemotherapy

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http://www.ingentaconnect.com/content/mksg/liv/2011/00000031/00000003/art00009

Hepatitis B screening, prophylaxis and re-activation in the era of

rituximab-based chemotherapy

Authors: Méndez-Navarro, ; Corey, Kathleen E.1; Zheng, Hui2; Barlow, Lydia

L.1; Jang, Jae Young; Lin, Wenyu1; Zhao, Hong1; Shao, Run-Xuan1; McAfee,

L.3; Chung, T.1

Source: Liver International, Volume 31, Number 3, March 2011 , pp. 330-339(10)

Publisher: Wiley-Blackwell

Abstract:

Background:

Hepatitis B re-activation is a well-described complication in patients with

inactive chronic hepatitis B receiving chemotherapy. Screening for HBV and

pre-emptive therapy are recommended. However, the rates of HBV screening,

prophylaxis and re-activation during rituximab-containing chemotherapy are

unknown.

Patients and methods:

We performed a retrospective study of patients with non-Hodgkin lymphoma (NHL)

who received rituximab between August 1997 and September 2009. We evaluated

patients for hepatitis B serologies, antiviral prophylaxis and hepatitis B

re-activation during or up to 6 months after chemotherapy.

Results:

One thousand four hundred and twenty-nine patients underwent

rituximab-containing chemotherapy for NHL. Hepatitis B serologies were

documented in 524 (36.6%) patients. Of these, 20 (3.8%) were HBsAg positive and

10 (50%) experienced HBV re-activation. Only half (5/10) had HBV serology

documented before re-activation. Only 3/8 (37.5%) of patients with newly

documented HBsAg positivity received antiviral prophylaxis. Virological

breakthrough occurred in two of the patients on chronic therapy, in one of three

inactive carriers on prophylaxis and in two of five patients not receiving

prophylaxis. Re-activation developed in another five patients not screened

previously for hepatitis B. One patient developed ALF and died. Re-activation

did not occur in 25 patients with isolated positive core antibody.

Conclusions:

At tertiary care institutions hepatitis B serologies are infrequently assessed

before rituximab-based chemotherapy and prophylaxis is uncommon. Greater

adherence to recommendations for screening and prophylaxis is necessary. This

suboptimal screening rate could be even lower in community hospitals and could

result in significant harm to unscreened and unprophylaxed patients.

Document Type: Research article

DOI: 10.1111/j.1478-3231.2010.02332.x

Affiliations: 1: Gastrointestinal Unit, Massachusetts General Hospital, Harvard

Medical School, Boston, MA, USA 2: MGH Biostatistics Center, Harvard Medical

School, Boston, MA, USA 3: Hematology/Oncology, Department of Medicine,

Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Publication date: 2011-03-01

[Guest guest]

http://www.ingentaconnect.com/content/mksg/liv/2011/00000031/00000003/art00009

Hepatitis B screening, prophylaxis and re-activation in the era of

rituximab-based chemotherapy

Authors: Méndez-Navarro, ; Corey, Kathleen E.1; Zheng, Hui2; Barlow, Lydia

L.1; Jang, Jae Young; Lin, Wenyu1; Zhao, Hong1; Shao, Run-Xuan1; McAfee,

L.3; Chung, T.1

Source: Liver International, Volume 31, Number 3, March 2011 , pp. 330-339(10)

Publisher: Wiley-Blackwell

Abstract:

Background:

Hepatitis B re-activation is a well-described complication in patients with

inactive chronic hepatitis B receiving chemotherapy. Screening for HBV and

pre-emptive therapy are recommended. However, the rates of HBV screening,

prophylaxis and re-activation during rituximab-containing chemotherapy are

unknown.

Patients and methods:

We performed a retrospective study of patients with non-Hodgkin lymphoma (NHL)

who received rituximab between August 1997 and September 2009. We evaluated

patients for hepatitis B serologies, antiviral prophylaxis and hepatitis B

re-activation during or up to 6 months after chemotherapy.

Results:

One thousand four hundred and twenty-nine patients underwent

rituximab-containing chemotherapy for NHL. Hepatitis B serologies were

documented in 524 (36.6%) patients. Of these, 20 (3.8%) were HBsAg positive and

10 (50%) experienced HBV re-activation. Only half (5/10) had HBV serology

documented before re-activation. Only 3/8 (37.5%) of patients with newly

documented HBsAg positivity received antiviral prophylaxis. Virological

breakthrough occurred in two of the patients on chronic therapy, in one of three

inactive carriers on prophylaxis and in two of five patients not receiving

prophylaxis. Re-activation developed in another five patients not screened

previously for hepatitis B. One patient developed ALF and died. Re-activation

did not occur in 25 patients with isolated positive core antibody.

Conclusions:

At tertiary care institutions hepatitis B serologies are infrequently assessed

before rituximab-based chemotherapy and prophylaxis is uncommon. Greater

adherence to recommendations for screening and prophylaxis is necessary. This

suboptimal screening rate could be even lower in community hospitals and could

result in significant harm to unscreened and unprophylaxed patients.

Document Type: Research article

DOI: 10.1111/j.1478-3231.2010.02332.x

Affiliations: 1: Gastrointestinal Unit, Massachusetts General Hospital, Harvard

Medical School, Boston, MA, USA 2: MGH Biostatistics Center, Harvard Medical

School, Boston, MA, USA 3: Hematology/Oncology, Department of Medicine,

Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

Publication date: 2011-03-01