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Risk of hepatitis B reactivation in HBsAg-negative/HBcAb-positive patients with undetectable serum HBV DNA after treatment with rituximab for lymphoma: a meta-analysis

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Abstract

Background

Hepatitis B surface antigen (HBsAg)-negative/hepatitis B core antibody (HBcAb)-positive patients with undetectable serum hepatitis B virus (HBV) DNA have experienced and resolved hepatitis B virus (HBV) infection. Lymphoma patients with resolved HBV infection have high risk of HBV reactivation when treated with robust immunosuppressive agents, but the reported rate varies extensively between different studies. This study aims to estimate the risk of HBV reactivation in HBsAg-negative/HBcAb-positive patients receiving rituximab-containing chemotherapy for lymphoma.

Methods

Databases were searched for papers published in English until 8 August 2016. The pooled risk of HBV reactivation was estimated using a random-effects model.

Results

Data from 15 studies were retrieved, including a total of 1312 HBsAg-negative/HBcAb-positive lymphoma patients treated with rituximab-containing chemotherapy. The results revealed HBV reactivation rate of 9.0 % [95 % confidence interval (CI) 0.05–0.15]. In subgroup analysis, the reactivation rates for prospective and retrospective studies were 17 % (I 2 = 87.3 %; 95 % 0.08–0.39, p < 0.001) and 7 % (I 2 = 43.1 %; 95 % CI 0.05–0.11, p = 0.07), respectively.

Conclusions

This meta-analysis confirms a measurable and potentially substantial risk of HBV reactivation in HBsAg-negative/HBcAb-positive patients with rituximab treatment for lymphoma. Prophylactic use of anti-HBV agents should be seriously considered for such patients.

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Acknowledgements

This work was supported by the National Natural Science Foundation (81373136, 81572010), Application Research of Capital Clinical Characteristic and Promotion of Achievements (Z151100004015011), and the Capital Health Development Research Special Independent Innovation Project (2016-2-5032).

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Author notes

  1. Zilin Tang and Xiaodong Li contributed equally to this work.

Authors and Affiliations

  1. Clinical Medical School, Guilin Medical University, Guilin, 541004, Guangxi Zhuang Autonomous Region, China

    Zilin Tang, Yan Qiao, Dongping Xu & Jin Li

  2. Research Center for Clinical and Translational Medicine/Institute of Infectious Diseases, Beijing 302 Hospital, Beijing, 100039, China

    Xiaodong Li, Shunquan Wu, Yan Liu, Dongping Xu & Jin Li

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  1. Zilin Tang
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  2. Xiaodong Li
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Correspondence to Dongping Xu or Jin Li.

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Conflict of interest

Zilin Tang, Xiaodong Li, Shunquan Wu, Yan Liu, Qiao Yan, Dongping Xu, and Jin Li declare that there are no conflicts of interest.

Human and animal rights statement

This study was approved by the ethics committee of Beijing 302 Hospital. This article does not contain any studies with human or animal subjects.

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Tang, Z., Li, X., Wu, S. et al. Risk of hepatitis B reactivation in HBsAg-negative/HBcAb-positive patients with undetectable serum HBV DNA after treatment with rituximab for lymphoma: a meta-analysis. Hepatol Int 11, 429–433 (2017). https://doi.org/10.1007/s12072-017-9817-y

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