title: Antiviral therapies for managing viral hepatitis in lymphoma patients.
abstract: In patients with lymphoma the detection of positive hepatitis B or C viruses (HBV and HCV) serology involves crucial therapeutic consequences. In HBV-infected patients the serological profile of active (HBsAg-positive) or resolved (HBsAg-negative/anti-HBcAb-positive) infection is associated to differential risk of viral reactivation during rituximab-based therapy and require appropriate strategies of monitoring and of antiviral prophylaxis. In HCV-associated NHL patients consolidated data demonstrated that interferon (IFN)-based antiviral therapy (AT) is able to induce lymphoma regression strictly related to viral eradication, while preliminary data of the new direct-acting antivirals (DAAs) are very promising. Areas covered: This review summarizes current evidences about HBV reactivation risk in patients undergoing rituximab-based treatments and appropriate options of antiviral prophylaxis with lamivudine, entecavir or tenofovir, as well as pre-emptive strategy in HBsAg-negative/HBcAb-positive patients. Moreover previous experiences with IFN-based AT as well as recent studies with DAAs in HCV-associated indolent lymphomas or diffuse large B-cell lymphoma (DLBCL) are reviewed. Expert opinion: Entecavir or tenofovir prophylaxis is recommended for HBsAg-positive patients, while universal prophilaxis with lamivudine may be preferred in HBsAg-negative/anti-HBc-positive patients. In asymptomatic patients with HCV-associated indolent lymphoma DAA-based AT should be used as first-line option, while in DLBCL its deliver after immunochemotherapy-induced complete remission is suggested.
authors.affiliation: a Division of Hematology , University Hospital Ospedale di Circolo & Fondazione Macchi, University of Insubria , Varese , Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Merli
authors.affiliation: b Department of Hematology-Oncology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Rattotti
authors.affiliation: b Department of Hematology-Oncology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gotti
authors.affiliation: b Department of Hematology-Oncology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.|c Department of Molecular Medicine , University of Pavia , Pavia , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Arcaini
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006509:Hepatitis B / Q000188:drug therapy*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000821:virology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy / Q000821:virology; D000069283:Rituximab / Q000008:administration & dosage; D000068698:Tenofovir; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine; D000069283:Rituximab; C413685:entecavir; D006147:Guanine; D000068698:Tenofovir
keywords: Hepatitis B virus; antiviral therapy; direct-acting antivirals; entecavir; hepatitis C virus; interferon; lamivudine; non-Hodgkin lymphoma; sofosbuvir; tenofovir