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Journal of Gastroenterology

, Volume 46, Issue 1, pp 9–16 | Cite as

Reactivation of hepatitis B virus following rituximab-plus-steroid combination chemotherapy

  • Shigeru Kusumoto
  • Yasuhito TanakaEmail author
  • Ryuzo Ueda
  • Masashi Mizokami
Review

Abstract

Reactivation of hepatitis B virus (HBV) has been reported as a fatal complication following systemic chemotherapy or other immunosuppressive therapy. The risk of HBV reactivation differs according to both the patient’s HBV infection status prior to systemic chemotherapy and the degree of immunosuppression due to chemotherapy. For establishing an optimal strategy for hepatitis prevention and treatment, it is necessary to understand the characteristics, the clinical course and the risk factors for HBV reactivation and to recognize the difference between hepatitis B surface antigen (HBsAg)-positive and -negative patients with HBV reactivation. Among the important viral risk factors, HBV-DNA level and HBV-related serum markers have been reported to be associated with HBV reactivation in addition to cccDNA, genotypes and gene mutations. Rituximab-plus-steroid combination chemotherapy has recently been identified as a host risk factor for HBV reactivation in hepatitis B core antibody (anti-HBc)-positive and/or hepatitis B surface antibody (anti-HBs) positive—but nonetheless HBsAg-negative—lymphoma patients. For these patients with resolved hepatitis B, preemptive therapy guided by serial HBV-DNA monitoring is a reasonable strategy to enable early diagnosis of HBV reactivation and initiation of antiviral therapy. In this review, we summarize the characteristics of HBV reactivation following rituximab-plus-steroid combination chemotherapy, mainly in HBsAg-negative lymphoma patients, and propose a strategy for managing HBV reactivation.

Keywords

Reactivation HBV Rituximab 

Abbreviations

Anti-HBc

Hepatitis B core antibody

Anti-HBs

Hepatitis B surface antibody

cccDNA

Covalently closed circular DNA

CHOP

Cyclophosphamide, doxorubicin, vincristine, prednisolone

HBsAg

Hepatitis B surface antigen

HBV

Hepatitis B virus

HSCT

Hematopoietic stem cell transplantation

R-CHOP

Rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone

RTD-PCR

Real-time detection PCR

Notes

Acknowledgments

Financial support was provided by the Ministry of Health, Labour and Welfare of Japan (grant-in-aid H20-kanen-014 to S.K.).

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Copyright information

© Springer 2010

Authors and Affiliations

  • Shigeru Kusumoto
    • 1
  • Yasuhito Tanaka
    • 2
    Email author
  • Ryuzo Ueda
    • 1
  • Masashi Mizokami
    • 3
  1. 1.Department of Medical Oncology and ImmunologyNagoya City University Graduate School of Medical Sciences Mizuho-ku, NagoyaJapan
  2. 2.Department of Virology and Liver UnitNagoya City University Graduate School of Medical Sciences Mizuho-ku, NagoyaJapan
  3. 3.Research Center for Hepatitis and ImmunologyInternational Medical Center of Japan Konodai HospitalIchikawaJapan

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