title: Lymphoproliferative Disease and Hepatitis B Reactivation: Challenges in the Era of Rapidly Evolving Targeted Therapy.
abstract: Reactivation of hepatitis B virus (HBV) is a known complication that occurs in patients receiving chemotherapy especially for malignant lymphoma. The increased risk in lymphoma patients parallels the potency of the immunosuppressive treatment regimens that are provided. B-cell-depleting therapy such as anti-CD20 monoclonal antibodies, especially when combined with conventional chemotherapy, significantly increases the risk of HBV reactivation, even in patients with resolved HBV infection. The first reports of HBV reactivation with anti-CD20 therapy emerged only 4 years after its US Food and Drug Administration approval. Today, these drugs carry alert warnings on the risk of hepatic dysfunction and reactivation of HBV infection. Many other new/novel agents active against lymphoma have emerged since then, targeting the different pathways involved in lymphoma pathogenesis, including histone deacetylase inhibitors, antibody-drug conjugates, and proteasome inhibitors. These various drugs have differing depths and mechanisms of immunosuppression, necessitating due diligence when administrating these compounds to prevent infective complications such as HBV reactivation, which can lead to liver failure and death. This review focuses on HBV reactivation with non-Hodgkin lymphoma treatment, in particular with the various approved novel agents. We also discuss the current recommendations for screening non-Hodgkin lymphoma patients for HBV and the role of prophylactic antiviral therapy during and after immunosuppressive treatment.
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore; Medicine Academic Clinical Programme, DUKE-NUS Graduate Medical School, Singapore. Electronic address: colin.phipps.diong@sgh.com.sg.
authors.forename: Colin
authors.initials: C
authors.lastname: Phipps
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore.
authors.forename: Yunxin
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Haematology, Singapore General Hospital, Singapore; Raffles Cancer Centre, Raffles Hospital, Singapore.
authors.forename: Daryl
authors.initials: D
authors.lastname: Tan
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology / Q000378:metabolism; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols; D000998:Antiviral Agents / Q000627:therapeutic use; D000069286:Bortezomib / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D006515:Hepatitis B virus / Q000276:immunology / Q000502:physiology*; D056572:Histone Deacetylase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008297:Male; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use; D014775:Virus Activation
chemical_list: D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D056572:Histone Deacetylase Inhibitors; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab; D000069283:Rituximab; D000069286:Bortezomib; C549035:mogamulizumab
keywords: Chemotherapy; Hepatitis B reactivation; Immunosuppression; Liver failure; Lymphoma