Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma

Kosei Matsue, Shun Ichi Kimura, Yoko Takanashi, Kan Ichi Iwama, Hideaki Fujiwara, Masayuki Yamakura, Masami Takeuchi

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

BACKGROUND: Reactivation of hepatitis B virus (HBV) after rituximab-containing chemotherapy in patients with B-cell lymphoma has been recognized as a potentially serious complication in HBV immune patients. METHODS: To determine the HBV reactivation in patients treated with rituximab, a retrospective study of HBV-related markers was performed before and after rituximab-containing treatment in 261 consecutive patients with CD20-positive B-cell lymphoma. RESULTS: Of the 261 patients, 230 patients were tested for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before treatment. Fifty-six (24.3%) of 230 patients were anti-HBc positive, and the remaining 174 (75.6%) patients were anti-HBc negative. Among the 56 anti-HBc-positive patients, 5 (8.9%) became HBsAg positive (HBV reactivation), whereas none of the 174 anti-HBc-negative patients became HBsAg positive with a median follow-up of 24 months (P =.001). Among the 5 patients with HBV reactivation, 4 were negative for antibody to HBsAg (anti-HBs), and 1 patient was positive for anti-HBs. All 5 of these patients were treated successfully with entecavir on detection of HBsAg, although 4 of the 5 patients exhibited mild to moderate elevation of alanine aminotransferase. Among 56 anti-HBc-positive patients, those negative for anti-HBs had a higher probability of developing HBV reactivation compared with those positive for anti-HBs (4 of 19; 21.1% vs 1 of 37; 2.7%, P =.014). CONCLUSIONS: Patients with isolated anti-HBc are at high risk of HBV reactivation and should be monitored closely for HBsAg, anti-HBs, HBV-DNA, and transaminase levels during and after rituximab-containing treatment. Although preemptive use of entecavir enabled successful management of HBV reactivation, mild to moderate hepatic flare was still observed. These approaches should be further evaluated in a prospective study with regard to clinical usefulness, safety, and cost-effectiveness.

Original languageEnglish
Pages (from-to)4769-4776
Number of pages8
JournalCancer
Volume116
Issue number20
DOIs
Publication statusPublished - 2010
Externally publishedYes

Fingerprint

B-Cell Lymphoma
Hepatitis B virus
Hepatitis B Core Antigens
Hepatitis B Surface Antigens
Therapeutics
Antibodies
Rituximab
Hepatitis B Antibodies
Transaminases
Alanine Transaminase
Cost-Benefit Analysis

Keywords

  • Antibody to hepatitis B core antigen
  • B-cell lymphoma
  • Hepatitis B virus
  • Reactivation
  • Rituximab

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Matsue, K., Kimura, S. I., Takanashi, Y., Iwama, K. I., Fujiwara, H., Yamakura, M., & Takeuchi, M. (2010). Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma. Cancer, 116(20), 4769-4776. https://doi.org/10.1002/cncr.25253

Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma. / Matsue, Kosei; Kimura, Shun Ichi; Takanashi, Yoko; Iwama, Kan Ichi; Fujiwara, Hideaki; Yamakura, Masayuki; Takeuchi, Masami.

In: Cancer, Vol. 116, No. 20, 2010, p. 4769-4776.

Research output: Contribution to journalArticle

Matsue, K, Kimura, SI, Takanashi, Y, Iwama, KI, Fujiwara, H, Yamakura, M & Takeuchi, M 2010, 'Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma', Cancer, vol. 116, no. 20, pp. 4769-4776. https://doi.org/10.1002/cncr.25253
Matsue, Kosei ; Kimura, Shun Ichi ; Takanashi, Yoko ; Iwama, Kan Ichi ; Fujiwara, Hideaki ; Yamakura, Masayuki ; Takeuchi, Masami. / Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma. In: Cancer. 2010 ; Vol. 116, No. 20. pp. 4769-4776.
@article{b54c5cd0c2554096b8ffe6826b9ccaaf,
title = "Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma",
abstract = "BACKGROUND: Reactivation of hepatitis B virus (HBV) after rituximab-containing chemotherapy in patients with B-cell lymphoma has been recognized as a potentially serious complication in HBV immune patients. METHODS: To determine the HBV reactivation in patients treated with rituximab, a retrospective study of HBV-related markers was performed before and after rituximab-containing treatment in 261 consecutive patients with CD20-positive B-cell lymphoma. RESULTS: Of the 261 patients, 230 patients were tested for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before treatment. Fifty-six (24.3{\%}) of 230 patients were anti-HBc positive, and the remaining 174 (75.6{\%}) patients were anti-HBc negative. Among the 56 anti-HBc-positive patients, 5 (8.9{\%}) became HBsAg positive (HBV reactivation), whereas none of the 174 anti-HBc-negative patients became HBsAg positive with a median follow-up of 24 months (P =.001). Among the 5 patients with HBV reactivation, 4 were negative for antibody to HBsAg (anti-HBs), and 1 patient was positive for anti-HBs. All 5 of these patients were treated successfully with entecavir on detection of HBsAg, although 4 of the 5 patients exhibited mild to moderate elevation of alanine aminotransferase. Among 56 anti-HBc-positive patients, those negative for anti-HBs had a higher probability of developing HBV reactivation compared with those positive for anti-HBs (4 of 19; 21.1{\%} vs 1 of 37; 2.7{\%}, P =.014). CONCLUSIONS: Patients with isolated anti-HBc are at high risk of HBV reactivation and should be monitored closely for HBsAg, anti-HBs, HBV-DNA, and transaminase levels during and after rituximab-containing treatment. Although preemptive use of entecavir enabled successful management of HBV reactivation, mild to moderate hepatic flare was still observed. These approaches should be further evaluated in a prospective study with regard to clinical usefulness, safety, and cost-effectiveness.",
keywords = "Antibody to hepatitis B core antigen, B-cell lymphoma, Hepatitis B virus, Reactivation, Rituximab",
author = "Kosei Matsue and Kimura, {Shun Ichi} and Yoko Takanashi and Iwama, {Kan Ichi} and Hideaki Fujiwara and Masayuki Yamakura and Masami Takeuchi",
year = "2010",
doi = "10.1002/cncr.25253",
language = "English",
volume = "116",
pages = "4769--4776",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "20",

}

TY - JOUR

T1 - Reactivation of hepatitis B virus after rituximab-containing treatment in patients with CD20-positive B-cell lymphoma

AU - Matsue, Kosei

AU - Kimura, Shun Ichi

AU - Takanashi, Yoko

AU - Iwama, Kan Ichi

AU - Fujiwara, Hideaki

AU - Yamakura, Masayuki

AU - Takeuchi, Masami

PY - 2010

Y1 - 2010

N2 - BACKGROUND: Reactivation of hepatitis B virus (HBV) after rituximab-containing chemotherapy in patients with B-cell lymphoma has been recognized as a potentially serious complication in HBV immune patients. METHODS: To determine the HBV reactivation in patients treated with rituximab, a retrospective study of HBV-related markers was performed before and after rituximab-containing treatment in 261 consecutive patients with CD20-positive B-cell lymphoma. RESULTS: Of the 261 patients, 230 patients were tested for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before treatment. Fifty-six (24.3%) of 230 patients were anti-HBc positive, and the remaining 174 (75.6%) patients were anti-HBc negative. Among the 56 anti-HBc-positive patients, 5 (8.9%) became HBsAg positive (HBV reactivation), whereas none of the 174 anti-HBc-negative patients became HBsAg positive with a median follow-up of 24 months (P =.001). Among the 5 patients with HBV reactivation, 4 were negative for antibody to HBsAg (anti-HBs), and 1 patient was positive for anti-HBs. All 5 of these patients were treated successfully with entecavir on detection of HBsAg, although 4 of the 5 patients exhibited mild to moderate elevation of alanine aminotransferase. Among 56 anti-HBc-positive patients, those negative for anti-HBs had a higher probability of developing HBV reactivation compared with those positive for anti-HBs (4 of 19; 21.1% vs 1 of 37; 2.7%, P =.014). CONCLUSIONS: Patients with isolated anti-HBc are at high risk of HBV reactivation and should be monitored closely for HBsAg, anti-HBs, HBV-DNA, and transaminase levels during and after rituximab-containing treatment. Although preemptive use of entecavir enabled successful management of HBV reactivation, mild to moderate hepatic flare was still observed. These approaches should be further evaluated in a prospective study with regard to clinical usefulness, safety, and cost-effectiveness.

AB - BACKGROUND: Reactivation of hepatitis B virus (HBV) after rituximab-containing chemotherapy in patients with B-cell lymphoma has been recognized as a potentially serious complication in HBV immune patients. METHODS: To determine the HBV reactivation in patients treated with rituximab, a retrospective study of HBV-related markers was performed before and after rituximab-containing treatment in 261 consecutive patients with CD20-positive B-cell lymphoma. RESULTS: Of the 261 patients, 230 patients were tested for both hepatitis B surface antigen (HBsAg) and antibody to hepatitis B core antigen (anti-HBc) before treatment. Fifty-six (24.3%) of 230 patients were anti-HBc positive, and the remaining 174 (75.6%) patients were anti-HBc negative. Among the 56 anti-HBc-positive patients, 5 (8.9%) became HBsAg positive (HBV reactivation), whereas none of the 174 anti-HBc-negative patients became HBsAg positive with a median follow-up of 24 months (P =.001). Among the 5 patients with HBV reactivation, 4 were negative for antibody to HBsAg (anti-HBs), and 1 patient was positive for anti-HBs. All 5 of these patients were treated successfully with entecavir on detection of HBsAg, although 4 of the 5 patients exhibited mild to moderate elevation of alanine aminotransferase. Among 56 anti-HBc-positive patients, those negative for anti-HBs had a higher probability of developing HBV reactivation compared with those positive for anti-HBs (4 of 19; 21.1% vs 1 of 37; 2.7%, P =.014). CONCLUSIONS: Patients with isolated anti-HBc are at high risk of HBV reactivation and should be monitored closely for HBsAg, anti-HBs, HBV-DNA, and transaminase levels during and after rituximab-containing treatment. Although preemptive use of entecavir enabled successful management of HBV reactivation, mild to moderate hepatic flare was still observed. These approaches should be further evaluated in a prospective study with regard to clinical usefulness, safety, and cost-effectiveness.

KW - Antibody to hepatitis B core antigen

KW - B-cell lymphoma

KW - Hepatitis B virus

KW - Reactivation

KW - Rituximab

UR - http://www.scopus.com/inward/record.url?scp=78349278037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78349278037&partnerID=8YFLogxK

U2 - 10.1002/cncr.25253

DO - 10.1002/cncr.25253

M3 - Article

C2 - 20597091

AN - SCOPUS:78349278037

VL - 116

SP - 4769

EP - 4776

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 20

ER -