COMMENTARY

Top 10 Practice Changers in Gastroenterology: 2014

David A. Johnson, MD

Disclosures

December 09, 2014

In This Article

Chemotherapy-Induced Hepatitis B Reactivation in Lymphoma Patients With Resolved HBV Infection: A Prospective Study

Hsu C, Tsou HH, Lin SJ, et al; Taiwan Cooperative Oncology Group
Hepatology. 2014;59:2092-2100

Can Hepatitis B Virus Reactivation Be Predicted?

Flares of hepatitis B can occur in hepatitis B surface antigen (HBsAg)-positive patients with cancer who are receiving immunosuppressive therapy, so routine prophylaxis antiviral treatment is recommended. However, little is known about the incidence, severity, and outcomes of hepatitis B reactivation in patients with resolved hepatitis B virus (HBV) infection (HBsAg-negative, but anti-surface or anti-core antibody–positive) who undergo immunosuppressive therapy for lymphoma.

This study evaluated 150 adults with resolved HBV infection and newly diagnosed non-Hodgkin lymphoma who received rituximab/CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone)-based chemotherapy. The rate of HBV reactivation was 10.4 per 100 person-years, and that of hepatitis flare was 6.4 per 100 person-years. No baseline clinical features predicted HBV reactivation.

Clinicians need to be aware that HBV reactivation is not uncommon among patients with resolved HBV infection who are undergoing rituximab-based chemotherapy. Monthly monitoring for reactivation—and, if needed, treatment with an antiviral agent—can limit morbidity and mortality. Serologic breakthrough (reappearance of HBsAg) was the most important predictor of HBV-related hepatitis flare. Clinicians need to look for the forthcoming American Gastroenterological Association Institute Guideline on prevention and treatment of hepatitis B virus reactivation during immunosuppressive drug therapy.[1]

Abstract

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