Re: Rituxan in your future? - you need HepB screen

[Guest guest]

Screening for HepB is non-trivial. There seem to be three tests that are

normally run and the combination of their results determines your status.

Evidently I had HepB at some point and my body developed its own immunity to it.

I am being watched at NIH and to make sure I would be eligible for their FO

treatment down the road, they ran the initial three HBV tests described below,

saw that there were two I was positive for so then ran a HepB DNA test that was

negative. Here is some more info I picked up while going through this " does she

or doesn't she " . (I ended up ok, but had a scary time waiting for results.)

* HBsAg (hepatitis B surface antigen) - This refers to the outer surface of the

hepatitis B virus that triggers an antibody response. A " positive " or " reactive "

HBsAg test result means that the person is infected with the hepatitis B virus.

This can be an " acute " or a " chronic " infection. Infected people can pass the

virus on to others through their blood.

* HBsAb or anti-HBs (hepatitis B surface antibody) - This refers to the

protective antibody that is produced in response to an infection. It appears

when a person has recovered from an acute infection and cleared the virus

(usually within six months) or responded successfully to the hepatitis B vaccine

shots. A " positive " or " reactive " HBsAb (or anti-HBs) test result indicates that

a person is " immune " to any future hepatitis B infection and is no longer

contagious. This test is not routinely included in blood bank screenings.

* HBcAb or anti-HBc (hepatitis B core antibody) - This refers to an antibody

that is produced in response to the core-antigen, a component of the hepatitis B

virus. However, this is not a protective antibody. In fact, it is usually

present in those chronically infected with hepatitis B. A " positive " or

" reactive " HBcAb (or anti-HBc) test result indicates a past or present

infection, but it could also be a false positive. The interpretation of this

test result depends on the first two test results. Its appearance with the

protective surface antibody (positive HBsAb or anti-HBs) indicates prior

infection and recovery. For chronically infected persons, it will usually appear

with the virus (positive HbsAg).

Hope this helps.

Lynn

[Guest guest]

Now a broader recommendation...

Recent NCCN conference:

" Every cancer patient undergoing chemotherapy should be tested for hepatitis B

virus (HBV) infection, said a presenter here at the National Comprehensive

Cancer Network (NCCN) 16th Annual Conference.

Chemotherapy and its related immunosuppression can cause a reactivation of HBV –

" a potentially fatal and preventable disease, " said Emmy Ludwig, MD, from

Memorial Sloan-Kettering Cancer Center in New York City.

" Reactivation may complicate cancer therapy, " said Dr. Ludwig, explaining that

delays in treatment can result.

Medscape: http://www.medscape.com/viewarticle/739169

~chris

>

> It is important that CLL patients taking ANY treatment that includes

> Rituxan (and possibly Arzerra) be screened for the Hepatitis B virus

> prior to treatment.

>

> Section 5.5 of the drug label states:

>

> Hepatitis B Virus (HBV) Reactivation

>

> Hepatitis B virus (HBV) reactivation with fulminant hepatitis, hepatic

failure, and death can occur in patients with hematologic malignancies treated

with Rituxan. The median time to the diagnosis of hepatitis was approximately 4

months after the initiation of Rituxan and approximately one month after the

last dose. Screen patients at high risk of HBV infection before initiation of

Rituxan. Closely monitor carriers of hepatitis B for clinical and laboratory

signs of active HBV infection for several months following Rituxan therapy.

>

> Discontinue Rituxan and any concomitant chemotherapy in patients who develop

viral hepatitis, and institute appropriate treatment including antiviral

therapy. Insufficient data exist regarding the safety of resuming Rituxan in

patients who develop hepatitis subsequent to HBV reactivation.

>

> Source FDA:

> http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/103705s5311lbl.pdf