title: High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy.
abstract: BACKGROUND
  Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with "resolved" HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression. Viral breakthrough occurs with non-compliance to therapy and, also, when drug-resistant mutants emerge. The risk might be higher in fragile patients as elderlies.
  
  
  OBJECTIVE
  Since no study addressed this question, we determined the rate of HBV-RS in patients >65years undergoing Rituximab-containing chemotherapies for NHLs.
  
  
  METHODS
  We evaluated 85 newly diagnosed NHL patients with resolved HBV infection, receiving Rituximab-containing chemotherapies. All received lamivudine. HBV DNA was checked at baseline, every 4 weeks, for 1year after completion of Rituximab cointaining regimens.
  
  
  RESULTS
  Nine patients (10%) had HBV reactivation and HBV related hepatitis. All received entecavir and recovered without consequences. HBV reactivation was more likely to occur after an average of five R-CHOP cycles or during Fludarabine.
  
  
  CONCLUSIONS
  The rate of viral breakthrough (VBK), in our study population, is high considering that the patients were HBV DNA negative at baseline and suggest that Lamivudine prevention may not be sufficient in this population.
authors: Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy. Electronic address: roberto.castelli@unimi.it.
authors: Roberto
authors: R
authors: Castelli
authors: Division of Infectious Disease, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy.
authors: Laurenzia
authors: L
authors: Ferraris
authors: UniSR-Social.Lab (Research Methods), Faculty of Psychology, San Raffaele University of Milan, Milan, Italy.
authors: Giuseppe
authors: G
authors: Pantaleo
authors: Mattarelli Foundation, Milan, Italy.
authors: Giorgio
authors: G
authors: Lambertenghi Deliliers
authors: Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital Milan, Milan, Italy.
authors: Marco
authors: M
authors: Cicardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000188:drug therapy / Q000453:epidemiology*; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D007558:Italy; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy; D008297:Male; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D014775:Virus Activation
chemical_list: D000970:Antineoplastic Agents; D000998:Antiviral Agents; D004279:DNA, Viral; D000069283:Rituximab
keywords: Elderlies; HBV reactivation; Non-Hodgkin lymphomas (NHLs); Rituximab-containing chemotherapies