Hepatitis B virus reactivation in a surface antigen-negative and antibody-positive patient after rituximab plus CHOP chemotherapy.
Rituximab is a monoclonal antibody that targets B-lymphocytes, and it is widely used to treat non-Hodgkin's lymphoma. However, its use has been implicated in HBV reactivation that's related with the immunosuppressive effects of rituximab. Although the majority of reactivations occur in hepatitis B carriers, a few cases of reactivation have been reported in HBsAg negative patients. However, reactivation in an HBsAg negative/HBsAb positive patient after rituximab treatment has never been reported in Korea. We present here an HBsAg-negative/HBsAb-positive 66-year-old female who displayed reactivation following rituximab plus CHOP chemotherapy for diffuse large B-cell lymphoma. While she was negative for HBsAg at diagnosis, her viral status was changed at the time of relapse as follows: HBsAg positive, HBsAb negative, HBeAg positive, HBeAb negative and an HBV DNA level of 1165 pg/ml. Our observation suggests that we should monitor for HBV reactivation during rituximab treatment when prior HBV infection or occult infection is suspected, and even in the HBsAg negative/HBsAb positive cases.
Kim
Eui Bae
EB
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Kim
Dae Sik
DS
Park
Seh Jong
SJ
Park
Yong
Y
Rho
Kyoung Ho
KH
Kim
Seok Jin
SJ
Proc Natl Acad Sci U S A. 1986 Mar;83(6):1627-31
3006059
J Infect Chemother. 2005 Aug;11(4):189-91
16133710
Ann Oncol. 1997;8 Suppl 1:107-9
9187442
Hepatology. 2001 Jul;34(1):204-6
11431752
Hepatology. 2001 Jul;34(1):194-203
11431751
Hepatology. 2001 Dec;34(6):1225-41
11732013
Leuk Lymphoma. 2007 Feb;48(2):431-3
17325912
Hepatology. 1998 Jun;27(6):1736-42
9620351
Expert Opin Drug Saf. 2005 May;4(3):599-608
15934864
J Infect. 2007 Feb;54(2):185-91
16564573
J Clin Oncol. 2004 Mar 1;22(5):927-34
14990649
Cancer Invest. 2006 Aug-Sep;24(5):548-52
16939967
N Engl J Med. 2001 Jan 4;344(1):68-9
11187122
Intern Med. 2006;45(11):721-4
16819252
J Viral Hepat. 2002 Jul;9(4):243-57
12081601