title: Hepatitis B virus reactivation in B-cell lymphoma patients treated with rituximab: analysis from the Asia Lymphoma Study Group.
abstract: BACKGROUND
  Hepatitis B virus (HBV) reactivation is increasing, as rituximab has become widely used for B-cell lymphoma. Thus, prevention and management of HBV reactivation are important in HBV-endemic areas.
  
  
  METHODS
  Hepatitis B virus (HBV) reactivation in HBV surface antigen (HBsAg)-positive patients and HBsAg-negative/HBV core antibody (HBcAb)-positive patients who received rituximab-containing chemotherapy was investigated by the Asia Lymphoma Study Group via retrospective (n=340), and the results were compared to cross-sectional analysis with patients who were prospectively monitored in a single institute (n=127). The goal of the study was to define the frequency of HBV reactivation and the efficacy of antiviral prophylaxis.
  
  
  RESULTS
  HBV reactivation was found in 27.8% of HBsAg-positive patients (45/162) in the retrospective analysis, being significantly less frequent in patients receiving antiviral prophylaxis than those not (22.9%, 32/140 versus 59.1%, 13/22; p<0.001). Lamivudine was most commonly used (96/162, 59.3%), but more than 20% of HBsAg-positive patients showed breakthrough HBV reactivation. In the cross-sectional analysis, a reduced rate of HBV reactivation occurred for entecavir as compared with lamivudine prophylaxis (6.3% versus 39.3%; p<0.05). HBV DNA monitoring of HBsAg-negative/HBcAb-positive patients in the cross-sectional analysis showed HBV reactivation in only 2.4% of cases.
  
  
  CONCLUSIONS
  This is the largest study of HBV reactivation in patients receiving rituximab-containing chemotherapy to date, and we defined the probability of HBV reactivation in an HBV-endemic region.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Chiun
authors.initials: C
authors.lastname: Hsu
authors.forename: Yu-Qin
authors.initials: YQ
authors.lastname: Song
authors.forename: Kevin
authors.initials: K
authors.lastname: Tay
authors.forename: Xiao-Nan
authors.initials: XN
authors.lastname: Hong
authors.forename: Junning
authors.initials: J
authors.lastname: Cao
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
authors.forename: Hyeon Seok
authors.initials: HS
authors.lastname: Eom
authors.forename: Joon Hyeok
authors.initials: JH
authors.lastname: Lee
authors.forename: Jun
authors.initials: J
authors.lastname: Zhu
authors.forename: Kian-Meng
authors.initials: KM
authors.lastname: Chang
authors.forename: Arry Harryanto
authors.initials: AH
authors.lastname: Reksodiputro
authors.forename: Daryl
authors.initials: D
authors.lastname: Tan
authors.forename: Yeow Tee
authors.initials: YT
authors.lastname: Goh
authors.forename: Jejung
authors.initials: J
authors.lastname: Lee
authors.forename: Tanin
authors.initials: T
authors.lastname: Intragumtornchai
authors.forename: Wee-Joo
authors.initials: WJ
authors.lastname: Chng
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.forename: Soon Thye
authors.initials: ST
authors.lastname: Lim
authors.forename: Cheolwon
authors.initials: C
authors.lastname: Suh
authors.forename: Yok-Lam
authors.initials: YL
authors.lastname: Kwong
authors.forename: Won Seog
authors.initials: WS
authors.lastname: Kim
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood; D019353:Endemic Diseases; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000187:drug effects* / Q000235:genetics / Q000276:immunology / Q000502:physiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome; D019562:Viral Load; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D000069283:Rituximab
keywords: B-cell; Hepatitis B virus; Lymphoma; Rituximab