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HBV Reactivation After Chemotherapy for Lymphoma

June 25, 2014

HBV Reactivation After Chemotherapy for Lymphoma

  1. Atif Zaman, MD, MPH

Incidence of reactivation was 10.4 cases per 100 person-years in patients with resolved HBV infection.

  1. Atif Zaman, MD, MPH

Routine prophylactic antiviral treatment is recommended for hepatitis B surface antigen (HBsAg)-positive cancer patients receiving immunosuppressive therapy, in whom hepatitis B virus (HBV) reactivation and hepatitis flare are common. Although cancer patients with resolved HBV infection (i.e., HBsAg-negative but anti-surface or anti-core antibody–positive) remain at increased risk for these conditions, incidence, severity, and outcomes are unknown.

In a multicenter, prospective study in Taiwan, researchers estimated rates of HBV reactivation (>10-fold increase in HBV DNA) and hepatitis flare (>3-fold increase in alanine aminotransferase [ALT] that exceeded 100 IU/mL) in 150 adult patients with newly diagnosed non-Hodgkin lymphoma and resolved HBV infection. Patients were to receive rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-based chemotherapy. HBV DNA was checked at baseline and monthly for 1 year after chemotherapy completion. Patients with reactivation were treated with 0.5 mg of entecavir daily for 48 weeks.

During a median follow-up of 27.4 months, HBV reactivation occurred in 17 patients (median time from start of chemotherapy, 21.0 weeks). Nine episodes occurred during the initial round of chemotherapy, three during second-line or additional chemotherapy, and six during follow-up. Ten patients developed HBV-related hepatitis flares, of which four cases were considered severe (ALT levels >10-fold higher than the upper normal limit); the median time from reactivation to hepatitis flare was 49 days. The rates of HBV reactivation and hepatitis flare were 10.4 and 6.4 per 100 person-years, respectively. No baseline clinical features were predictive of HBV reactivation.

Comment

This important study clearly demonstrates that HBV reactivation is not uncommon among patients with resolved HBV infection who are undergoing rituximab-based chemotherapy. Fortunately, monthly monitoring for reactivation — and, if needed, treatment with an antiviral agent — prevents significant morbidity and mortality; in this study, no hepatitis-related deaths occurred, and only two patients required reactivation-related delay in chemotherapy. Clinicians should be mindful of HBV reactivation in cancer patients with chronic or resolved HBV infection who are undergoing intense chemotherapy.

  • Disclosures for Atif Zaman, MD, MPH at time of publication Nothing to disclose

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Reader Comments (1)

Lavanya vinukonda Physician, Internal Medicine, India

In my observation such cases needs integrated approach where it will minimize the adverse effects as well as it improves the quality & quantity (life span) of life .

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