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Low incidence of hepatitis B virus reactivation during chemotherapy among diffuse large B-cell lymphoma patients who are HBsAg-negative/ HBcAb-positive: a multicenter retrospective study


Junning Cao, MD, Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China. Tel: +86 21 64175590 8216; Fax: +86 21 64430160; e-mail:


Background:  Reactivation of hepatitis B virus (HBV) is less common in lymphoma patients with prior resolved HBV infection [characterized by hepatitis B surface antigen (HBsAg)-negative/hepatitis B core antibody (HBcAb)-positive status] compared with chronic HBV infection (HBsAg positive) when receiving chemotherapy alone. The use of rituximab in chemotherapy regimen might increase the risk of HBV reactivation in patients with prior resolved HBV infection. However, the incidence of HBV reactivation is uncertain, and prophylactic antiviral treatment for this group of patients during rituximab-containing chemotherapy is controversial. The objective of this study was to determine the incidence of HBV reactivation in HBsAg-negative/HBcAb-positive patients diagnosed of diffuse large B-cell lymphoma (DLBCL) and treated with CHOP-like or RCHOP-like regimen. In addition, this study also aims to explore the relationship of HBV reactivation and HBV serology.

Methods:  Patients were identified using data from six university hospitals collected between January 1998 and November 2008. Four hundred and thirty-seven patients with complete data were selected based on the diagnosis of CD20+ DLBCL, availability of HBV serum markers prior to initiation of chemotherapy and during the development of hepatitis, completion of at least four cycles of chemotherapy using CHOP-like or RCHOP-like regimen, and follow-up for at least 6 months after completion of treatment. The characteristics of the HBsAg-negative/HBcAb-positive patients treated with CHOP-like regimen were compared to those treated with RCHOP-like regimen.

Results:  Eighty-eight patients of the total 437 patients had pretreatment serology of prior resolved hepatitis B, with a prevalence of 20.1%. Among them, 45 patients received CHOP-like regimen while 43 patients received RCHOP-like regimen. Five patients developed hepatitis during treatment, two from CHOP group and three from RCHOP group. Only one patient treated with RCHOP had hepatitis associated with HBV reactivation, while the other four patients did not have evidence of HBV reactivation. Those four patients also demonstrated positive HBsAb at baseline, while the only patient who suffered from HBV reactivation had negative HBsAb status. This patient was successfully treated with antiviral medications. There were no statistically significant risk factors predictive of HBV reactivation.

Conclusions:  The present study revealed a low HBV reactivation rate of 2.3% in prior resolved hepatitis B among DLBCL patients undergoing RCHOP-like therapy.

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