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Annals of Hematology

, Volume 90, Issue 10, pp 1219–1223 | Cite as

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

  • Yu Xuan Koo
  • Matthew Tay
  • Yii Ean Teh
  • David Teng
  • Daniel S. W. Tan
  • Iain B. H. Tan
  • David W. M. Tai
  • Richard Quek
  • Miriam Tao
  • Soon Thye LimEmail author
Original Article

Abstract

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.

Keywords

Lymphoma Non-Hodgkin Hepatitis B virus Hepatitis B surface antigens Lamivudine Rituximab Antibodies Monoclonal 

Notes

Conflict of interest and source of funding

There are no financial disclosures from any authors. The authors report no conflicts of interests.

Condensed Abstract

The risk of HBV reactivation is low in patients who are HBsAg negative/anti-HBc positive receiving rituximab-based combination chemotherapy without concomitant antiviral prophylaxis. Close surveillance instead of routine antiviral prophylaxis is a viable option for this group of patients.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Yu Xuan Koo
    • 1
    • 2
  • Matthew Tay
    • 1
    • 2
  • Yii Ean Teh
    • 1
    • 2
  • David Teng
    • 1
    • 2
  • Daniel S. W. Tan
    • 1
  • Iain B. H. Tan
    • 1
  • David W. M. Tai
    • 1
  • Richard Quek
    • 1
  • Miriam Tao
    • 1
  • Soon Thye Lim
    • 1
    Email author
  1. 1.Department of Medical OncologyNational Cancer Centre SingaporeSingaporeSingapore
  2. 2.Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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