Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-based chemotherapy
Article first published online: 25 AUG 2010
© 2010 John Wiley & Sons A/S
Volume 31, Issue 3, pages 330–339, March 2011
How to Cite
Méndez-Navarro, J., Corey, K. E., Zheng, H., Barlow, L. L., Jang, J. Y., Lin, W., Zhao, H., Shao, R.-X., McAfee, S. L. and Chung, R. T. (2011), Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-based chemotherapy. Liver International, 31: 330–339. doi: 10.1111/j.1478-3231.2010.02332.x
- Issue published online: 1 FEB 2011
- Article first published online: 25 AUG 2010
- Received 19 April 2010, Accepted 21 July 2010
- HBV prophylaxis;
- HBV re-activation;
- hepatitis B;
- non-Hodgkin lymphoma;
Background: Hepatitis B re-activation is a well-described complication in patients with inactive chronic hepatitis B receiving chemotherapy. Screening for HBV and pre-emptive therapy are recommended. However, the rates of HBV screening, prophylaxis and re-activation during rituximab-containing chemotherapy are unknown.
Patients and methods: We performed a retrospective study of patients with non-Hodgkin lymphoma (NHL) who received rituximab between August 1997 and September 2009. We evaluated patients for hepatitis B serologies, antiviral prophylaxis and hepatitis B re-activation during or up to 6 months after chemotherapy.
Results: One thousand four hundred and twenty-nine patients underwent rituximab-containing chemotherapy for NHL. Hepatitis B serologies were documented in 524 (36.6%) patients. Of these, 20 (3.8%) were HBsAg positive and 10 (50%) experienced HBV re-activation. Only half (5/10) had HBV serology documented before re-activation. Only 3/8 (37.5%) of patients with newly documented HBsAg positivity received antiviral prophylaxis. Virological breakthrough occurred in two of the patients on chronic therapy, in one of three inactive carriers on prophylaxis and in two of five patients not receiving prophylaxis. Re-activation developed in another five patients not screened previously for hepatitis B. One patient developed ALF and died. Re-activation did not occur in 25 patients with isolated positive core antibody.
Conclusions: At tertiary care institutions hepatitis B serologies are infrequently assessed before rituximab-based chemotherapy and prophylaxis is uncommon. Greater adherence to recommendations for screening and prophylaxis is necessary. This suboptimal screening rate could be even lower in community hospitals and could result in significant harm to unscreened and unprophylaxed patients.