Skip to main content

Advertisement

SpringerLink
Log in

Retrospective analysis of hepatitis B virus reactivation after rituximab combination chemotherapy in patients with B-cell lymphoma

  • Published:
The Chinese-German Journal of Clinical Oncology

Abstract

Objective

The aim of the study was to investigate the reactivations of hepatitis B virus (HBV) after rituximab-containing chemotherapy in patients with B-cell lymphoma with surface antigen of hepatitis B virus (HBsAg)-positive, or hepatitis B core antibody (HBcAb)-positive.

Methods

A retrospective study of HBV-related markers was performed before and after rituximab-containing treatment in 189 consecutive patients with CD20-positive B-cell lymphoma.

Results

Among the 189 non-Hodgkin’s lymphoma (NHL) patients who received rituximab combination chemotherapy, 31 (16.6%) were HBsAg positive and 82 (43.9%) HBsAg negative/HBcAb positive, and 76 were HBsAg and HBcAb negative. Of the 31 HBsAg positive patients, 3 (9.7%) experienced reactivation of HBV. The prevalence of HBV reactivation was 4.0% (1/25) in patients who received prophylactic antiviral treatment and 33.3% (2/6) in those who did not receive prophylactic antiviral treatment (P = 0.032). Prophylactic antiviral treatment decreased the rate of HBV reactivation. Among the 82 HBsAg negative/HBcAb positive patients, 1 (1.2%) experienced HBV reactivation leading to serious hepatitis.

Conclusion

Our experience indicates that rituximab-based therapy may cause serious HBV-related complications and even death in HBsAg-positive patients. Preemptive use of antiviral treatment enabled successful management of HBV reactivation. In HBsAg-negative and HBcAb-positive lymphoma patients the prevalence of HBV reactivation is low (1.2%). Close monitoring HBV until at least 6 months after anticancer therapy is required, prophylactic antiviral therapy needs to be evaluated further.

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

Similar content being viewed by others

References

  1. Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China — declining HBV prevalence due to hepatitis B vaccination. Vaccine, 2009, 27: 6550–6557.

    Article  PubMed  Google Scholar 

  2. Marcucci F, Mele A, Spada E, et al. High prevalence of hepatitis B virus infection in B-cell non-Hodgkin’s lymphoma. Haematologica, 2006, 91: 554–557.

    PubMed  Google Scholar 

  3. Park SC, Jeong SH, Kim J, et al. High prevalence of hepatitis B virus infection in patients with B-cell non-Hodgkin’s lymphoma in Korea. J Med Virol, 2008, 80: 960–966.

    Article  PubMed  CAS  Google Scholar 

  4. Chen MH, Hsiao LT, Chiou TJ, et al. High prevalence of occult hepatitis B virus infection in patients with B cell non-Hodgkin’s lymphoma. Ann Hematol, 2008, 87: 475–480.

    Article  PubMed  Google Scholar 

  5. Wang F, Xu RH, Han B, et al. High incidence of hepatitis B virus infection in B-cell subtype non-Hodgkin lymphoma compared with other cancers. Cancer, 2007, 109: 1360–1364.

    Article  PubMed  Google Scholar 

  6. Yeo W, Chan PK, Ho WM, et al. Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis B s-antigen seropositive cancer patients undergoing cytotoxic chemotherapy. J Clin Oncol, 2004, 22: 927–934.

    Article  PubMed  CAS  Google Scholar 

  7. Lau GK, Yiu HH, Fong DY, et al. Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy. Gastroenterology, 2003, 125: 1742–1749.

    Article  PubMed  CAS  Google Scholar 

  8. Hsu C, Hsiung CA, Su IJ, et al. A revisit of prophylactic lamivudine for chemotherapy-associated hepatitis B reactivation in non-Hodgkin’s lymphoma: a randomized trial. Hepatology, 2008, 47: 844–853.

    Article  PubMed  CAS  Google Scholar 

  9. Shibolet O, Ilan Y, Gillis S, et al. Lamivudine therapy for prevention of immunosuppressive-induced hepatitis B virus reactivation in hepatitis B surface antigen carriers. Blood, 2002, 100: 391–396.

    Article  PubMed  CAS  Google Scholar 

  10. Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med, 2002, 346: 235–242.

    Article  PubMed  CAS  Google Scholar 

  11. Pfreundschuh M, Trümper L, Osterborg A, et al. CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol, 2006, 7: 379–391.

    Article  PubMed  CAS  Google Scholar 

  12. Habermann TM, Weller EA, Morrison VA, et al. Rituximab-CHOP versus CHOP alone or with maintenance rituximab in older patients with diffuse large B-cell lymphoma. J Clin Oncol, 2006, 24: 3121–3127.

    Article  PubMed  CAS  Google Scholar 

  13. Dervite I, Hober D, Morel P. et al. Acute hepatitis B in a patient with antibodies to hepatitis B surface antigen who was receiving rituximab. N Engl J Med, 2001, 344: 68–69.

    Article  PubMed  CAS  Google Scholar 

  14. Skrabs C, Müller C, Agis H, et al. Treatment of HBV-carrying lymphoma patients with Rituximab and CHOP: a diagnostic and therapeutic challenge. Leukemia, 2002, 16: 1884–1886.

    Article  PubMed  CAS  Google Scholar 

  15. Nath A, Agarwal R, Malhotra P, et al. Prevalence of hepatitis B virus infection in non-Hodgkin lymphoma: a systematic review and metaanalysis. Intern Med J, 2010, 40: 633–641.

    Article  PubMed  CAS  Google Scholar 

  16. Chen MH, Hsiao LT, Chiou TJ, et al. High prevalence of occult hepatitis B virus infection in patients with B cell non-Hodgkin’s lymphoma. Ann Hematol, 2008, 87: 475–480.

    Article  PubMed  Google Scholar 

  17. Méndez-Navarro J, Corey KE, Zheng H, et al. Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-based chemotherapy. Liver Int, 2011, 31: 330–339.

    Article  PubMed  Google Scholar 

  18. 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: 605–611.

    Article  PubMed  CAS  Google Scholar 

  19. Koo YX, Tan DS, Tan BH, et al. Risk of hepatitis B virus reactivation in patients who are hepatitis B surface antigen negative/antibody to hepatitis B core antigen positive and the role of routine antiviral prophylaxis. J Clin Oncol, 2009, 27: 2570–2571.

    Article  PubMed  Google Scholar 

  20. Ziakas PD, Karsaliakos P, Mylonakis E, et al. Effect of prophylactic lamivudine for chemotherapy-associated hepatitis B reactivation in lymphoma: a meta-analysis of published clinical trials and a decision tree addressing prolonged prophylaxis and maintenance. Haematologica, 2009, 94: 998–1005.

    Article  PubMed  Google Scholar 

  21. Pei SN, Chen CH, Lee CM, et al. Reactivation of hepatitis B virus following rituximab-based regimens: a serious complication in both HBsAg-positive and HBsAg-negative patients. Ann Hematol, 2010, 89: 255–262.

    Article  PubMed  CAS  Google Scholar 

  22. Fukushima N, Mizuta T, Tanaka M, et al. Retrospective and prospective studies of hepatitis B virus reactivation in malignant lymphoma with occult HBV carrier. Ann Oncol, 2009, 20: 2013–2017.

    Article  PubMed  CAS  Google Scholar 

  23. 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: 4769–4776.

    Article  PubMed  Google Scholar 

  24. Niitsu N, Hagiwara Y, Tanae K, et al. Prospective analysis of hepatitis B virus reactivation in patients with diffuse large B-cell lymphoma after rituximab combination chemotherapy. J Clin Oncol, 2010, 28: 5097–5100.

    Article  PubMed  CAS  Google Scholar 

  25. Ji D, Cao J, Hong X, et al. Low incidence of hepatitis B virus reactivation during chemotherapy among diffuse large B-cell lymphoma patients who are HBsAg-negative/HBcAb-positive: a multicenter retrospective study. Eur J Haematol, 2010, 85: 243–250.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Chemo-therapy Center, Zhejiang Cancer Hospital, Hangzhou, 310022, China

    Yun Fan, Chong Luo, Lvhong Luo, Zhiyu Huang & Haifeng Yu

Authors
  1. Yun Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chong Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lvhong Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zhiyu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haifeng Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yun Fan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fan, Y., Luo, C., Luo, L. et al. Retrospective analysis of hepatitis B virus reactivation after rituximab combination chemotherapy in patients with B-cell lymphoma. Chin. -Ger. J. Clin. Oncol. 10, 721–725 (2011). https://doi.org/10.1007/s10330-011-0875-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10330-011-0875-7

Key words

Search

Navigation