Skip to main content

Advertisement

SpringerLink
Log in

Late reactivation of hepatitis B virus after rituximab-containing chemotherapy for mantle cell lymphoma: a case report

  • Case Report
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Background

Hepatitis B virus (HBV) reactivation is commonly observed in HBsAg-positive hematologic patients undergoing immunosuppressive chemotherapy. Recent guidelines recommend antiviral prophylaxis to be continued for up to 12 months after the discontinuation of the anticancer regimen.

Case Presentation

We report a case of a patient who underwent antiviral prophylaxis for 26 months after the discontinuation of a rituximab-containing chemotherapy regimen for a lymphoma and was admitted in the infectious diseases department with a 3-day history of jaundice, itching, and dark urine. After excluding other possible causes of acute liver damage, HBV reactivation was suspected. HBV-DNA was 4497000 IU/mL. Following reintroduction of entecavir, we observed a steady decline of ALT, AST, bilirubin and HBV-DNA serum levels, with a rapid resolution of acute hepatitis and an improvement in clinical conditions; one year after the event of HBV reactivation and beginning of antiviral therapy, the patient was virologically suppressed.

Discussion

Our study demonstrates that the risk of HBV reactivation in HBsAg-positive patients with undetectable HBV-DNA can occur even after three years from the last administration of rituximab and several months after the withdrawal of prophylactic antiviral therapy in patients with hematological malignancies. This implies that a close monitoring of HBV-related markers including HBV-DNA must continue after the withdrawal of prophylactic NA therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Marzano A, Bruno R, Fagiuoli S, et al. Gestione Clinica della Epatite B negli immunocompromessi: aggiornamento italiano 2017. Documento AISF. 2017.

  2. Coluccio C, Begini P, Marzano A, Pellicelli A, Imperatrice B, Anania G, Delle Fave G, Marignani M. Hepatitis B in patients with hematological diseases: an update. World J Hepatol. 2017;9:1043–53.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Yeo W, Chan TC, Leung NW, et al. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J Clin Oncol. 2009;27:605–11. https://doi.org/10.1200/JCO.2008.18.0182.

    Article  CAS  PubMed  Google Scholar 

  4. Koo YX, Tay M, Teh YE, et al. 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. Ann Hematol. 2011;90:1219–23. https://doi.org/10.1007/s00277-011-1241-0.

    Article  CAS  PubMed  Google Scholar 

  5. Reddy KR, Beavers KL, Hammond SP, et al. American Gastroenterological Association Institute guideline on the prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy. Gastroenterology. 2015;148:215–9. https://doi.org/10.1053/j.gastro.2014.10.039 (quiz e16–7).

    Article  CAS  PubMed  Google Scholar 

  6. Lok ASF, Liang RHS, Chiu EKW, et al. Reactivation of hepatitis B virus replication in patients receiving cytotoxic therapy. Report of a prospective study. Gastroenterology. 2001;100:182–8.

    Article  Google Scholar 

  7. Mélet J, Mulleman D, Goupille P, et al. Rituximab-induced T cell depletion in patients with rheumatoid arthritis: association with clinical response. Arthritis Rheum. 2013;65:2783–90. https://doi.org/10.1002/art.38107.

    Article  CAS  PubMed  Google Scholar 

  8. European Association for the Study of the Liver. EASL 2017 clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370–98. https://doi.org/10.1016/j.jhep.2017.03.021.

    Article  Google Scholar 

  9. Viganò M, Serra G, Casella G, et al. Reactivation of hepatitis B virus during targeted therapies for cancer and immune-mediated disorders. Expert Opin Biol Ther. 2016;16:917–26. https://doi.org/10.1080/14712598.2016.1177017.

    Article  CAS  PubMed  Google Scholar 

  10. Li H, Zhang HM, Chen LF, et al. Prophylactic lamivudine to improve the outcome of HBsAgpositive lymphoma patients during chemotherapy: a systematic review and meta-analysis. Clin Res Hepatol Gastroenterol 2015.

  11. Li HR, Huang JJ, Guo HQ, et al. Comparison of entecavir and lamivudine in preventing hepatitis B reactivation in lymphoma patients during chemotherapy. J Viral Hepat. 2011;18:877–83.

    Article  PubMed  Google Scholar 

  12. Huang H, Li X, Zhu J, Ye S. Entecavir vs lamivudine for prevention of hepatitis B virus reactivation among patients with untreated diffuse large B-cell lymphoma receiving R-CHOP chemotherapy: a randomized clinical trial. JAMA. 2014;312:2521–30.

    Article  CAS  PubMed  Google Scholar 

  13. Lalazar G, Rund D, Shouval D. Screening, prevention and treatment of viral hepatitis B reactivation in patients with haematological malignancies. Br J Haematol. 2007;136:699–712 (Review. Erratum in: Br J Haematol. 2007 Apr;137(1):81).

    Article  CAS  PubMed  Google Scholar 

  14. Pattullo V. Prevention of Hepatitis B reactivation in the setting of immunosuppression. Clin Mol Hepatol. 2016;22:219–37.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Matsue K, Kimura S, Takanashi Y, et al. Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma. Cancer. 2010;116:4769–76. https://doi.org/10.1002/cncr.25253.

    Article  PubMed  Google Scholar 

Download references

Funding

This manuscript was not funded.

Author information

Authors and Affiliations

  1. Institute of Clinical Infectious Diseases, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy

    Arturo Ciccullo & F. Pallavicini

  2. Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Agostino Gemelli Hospital, Catholic University, Rome, Italy

    F. R. Ponziani & M. Pompili

  3. Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy

    E. Maiolo

Authors
  1. Arturo Ciccullo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. R. Ponziani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Maiolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Pallavicini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Pompili
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arturo Ciccullo.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ciccullo, A., Ponziani, F.R., Maiolo, E. et al. Late reactivation of hepatitis B virus after rituximab-containing chemotherapy for mantle cell lymphoma: a case report. Infection 47, 313–316 (2019). https://doi.org/10.1007/s15010-018-1242-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-018-1242-1

Keywords

Search

Navigation