Hepatitis B and C Virus Reactivation Patterns in a Romanian Cohort of Patients with Chronic Lymphoproliferative Disorders
- 3 Downloads
Hepatitis B and C virus (HBV and HCV) reactivations have become more common following the intensive use of biological therapies for the treatment of chronic lymphoproliferative disorders (CLD). We evaluate risk factors for virus reactivation and exitus in patients diagnosed with CLD and HBV or HCV infection, undergoing rituximab-chemotherapy (R-chemo). A prospective, observational study in two tertiary-care Romanian hospitals, between December 2007 and May 2010, of patients diagnosed with CLD undergoing R-chemo. HBV and HCV serological markers, viral load, fibrosis and necroinflammation were assessed at baseline and every 3–6 months. We screened 502 patients diagnosed with CLDs (77.2% non-Hodgkin lymphomas) and enrolled 57 patients with HBV and/or HCV infection with a mean age of 61.35 ± 11.1 years. The replicative virus was HBV in 23 patients (40.3%), HCV in 33 patients (57.9%). HCV reactivation rate (15.6%) was lower than for HBV (45.5%) (p = 0.02). In univariate analysis, viral reactivation was associated with aggressive CLD (p = 0.01), HBV (p = 0.01) and lymphopenia (p = 0.02). Death was associated with aggressive CLD (p = 0.01), viral reactivation (p = 0.001) and high baseline viremia (p = 0.05). In multivariate analysis, viral reactivation was associated with lymphopenia (OR 0.05, 95% CI 0.003–0.85, p = 0.03). Risk of death was 10 times higher for patients with viral reactivation (95% CI 1.54–65.5, p = 0.01). A quarter of the infected patients were diagnosed with viral reactivation. While hepatitis C was more prevalent than hepatitis B in patients with CLD, viral reactivation was found 3 times more frequently in patients with hepatitis B than C.
KeywordsLymphoproliferative disorders Hepatitis B virus reactivation Hepatitis C virus reactivation Biological therapies
Hepatitis B virus
Hepatitis C virus
Chronic lymphoproliferative disorder
Chronic hepatitis B
Chronic hepatitis C
The current study belongs to a national Grant PNCDI-II/41-012/2007, known as LIMFO-VIR.
All authors had equal contributions in writing this paper.
Conflict of interest
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This study was approved by the Ethics Committee of the National Institute for Infectious Diseases “Prof. Dr. Matei Balş” and the University Emergency Hospital Bucharest, Bucharest, Romania.
- 1.Popovici O, Molnar G, Janta D (2014) Rezultatele studiului sero-epidemiologic de prevalenta pentru infectia cu virus hepatitic B si virus hepatitic C. In: National conference of microbiology and epidemiology (Conferinta Nationala de Microbiologie si Epidemiologie), Bucharest, 13–15 November 2014Google Scholar
- 5.American Association for the Study of liver diseases emerging trends conference, Reactivation of Hepatitis B, Arlington: March 21–22, 2013Google Scholar
- 6.Harris NE, Jaffe ES, Stein H (1994) A revised European–American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood 84:1361–1392Google Scholar
- 8.Swerldlow SH, Campo E, Harris NL (2008) In: WHO classification of tumours of haematopietic and lymphoid tissues. International Agency for Research in Cancer/IACRS Press, LyonGoogle Scholar
- 9.Porter RS, Kaplan JL (2011) Neutropenia and lymphocytopenia, chap 107. In: Merck manual of diagnosis and therapy, 19th edn. Merck Sharp Dohme Corp., Whitehouse StationGoogle Scholar
- 10.Kawsar Hameem I, Shahnewaz J, Gopalakrishna KV, Spiro TP, Daw HA (2012) Role of prechemotherapy screening and antiviral prophylaxis. Clin Adv Hematol Oncol 10(6):370–378Google Scholar
- 13.Yang F, Zhu HL, He C, Li JJ, Xiang B, Cui X et al (2014) Effect of antiviral prophylaxis strategy for chemotherapy-associated hepatitis B reactivation in non-Hodgkin’s lymphoma patients with hepatitis B virus infection: a retrospective cohort study. Indian J Hematol Blood Transfus 30(2):97–104CrossRefGoogle Scholar
- 17.Drugan C, Brichler S, Muntean M, Olteanu I, Carstina D, Drugan T et al (2008) Genotipe of hepatitis B virus in Romanian patients. Appl Med Inform 22(1–2):27–32Google Scholar
- 23.Markovic S, Drozina G, Vovk M, Fidler-Jenko M (1999) Reactivation of hepatitis B but not hepatitis C in patients with malignant lymphoma and immunosuppressive therapy. A prospective study in 305 patients. Hepatogastroenterology 46(29):2925–2930Google Scholar
- 25.Lee GW, Ryu MH, Lee JL, Oh S, Kime E, Lee JH et al (2003) The prophylactic use of lamivudine can maintain dose-intensity of adriamycin in hepatitis-B surface antigen (HBs Ag)-positive patients with non-Hodgkin’s lymphoma who receive cytotoxic chemotherapy. J Korean Med Sci 18:849–854CrossRefGoogle Scholar
- 28.Lim R, Holt A (2014) Hepatitis B and C prophylaxis in patients receiving chemotherapy. Viral Hepat Pract 6(1):10–13Google Scholar
- 29.Faggioli P, De Paschale M, Tocci A, Luoni M, Fava S, De Paoli A et al (1997) Acute hepatic toxicity during cyclic chemotherapy in non Hodgkin’s lymphoma. Haematologica 82:38–42Google Scholar