Abstract 4794

Background

In surface antigen of hepatitis B virus (HBsAg)-positive carrier for anticancer treatment of malignant lymphoma, it is well recognized that reactivation of hepatitis B virus (HBV) occasionally occurs. However, there have been only a few studies of HBV reactivation in serum HBsAg-negative and hepatitis B core antigen (HBcAb)-positive occult HBV carriers. We looked at both retrospective and prospective studies to determine the prevalence, clinical course and risk factor of HBV reactivation during chemotherapy in lymphoma patients.

Patients and methods

Forty-nine of 128 (38.3%) lymphoma patients were HBsAg negative and HBcAb positive, and 25 of these patients were then given liver function tests and HBsAg tests monthly and serum HBV DNA every 3 months.

Results

HBV reactivation was observed in two patients (4.0%) who had received intensive chemotherapy including steroid and rituximab. Immediate administration of entecavir therapy after elevation of HBV DNA level was conducted, and this resulted in reduction of it and improvement of liver function test.

Conclusions

Rituximab plus steroid-containing regimens may increase the risk of HBV reactivation in HBsAgnegative and HBcAb-positive lymphoma patients. More ambitious prospective studies are required to establish clinically useful or cost-effective follow-up methods for control of HBV reactivation in lymphoma patients with occult HBV infection.

Summary in patients registered in HBc Rx-05 (Prospective study)

n=25
Age (median) 40-85 (70) 
Sex M/F 13/12 
subtype  
B-cell 22 
T-cell 3 
Number of HBsAg positive 0 
Titer of HBsAb (medan) 0-2382 (30) 
Titer of HBcAb (median) 1.3-14.5 (5.89) 
Number of high titer HBcAb (>10.0 S/CO) 7 
Number of high HBV-DNA (>2.6 log copy/ml) 0 
ALT (IU/l) 9-125 (17) 
number of patients used rituximab 22 
number of HBV reactivation (+) 1 
n=25
Age (median) 40-85 (70) 
Sex M/F 13/12 
subtype  
B-cell 22 
T-cell 3 
Number of HBsAg positive 0 
Titer of HBsAb (medan) 0-2382 (30) 
Titer of HBcAb (median) 1.3-14.5 (5.89) 
Number of high titer HBcAb (>10.0 S/CO) 7 
Number of high HBV-DNA (>2.6 log copy/ml) 0 
ALT (IU/l) 9-125 (17) 
number of patients used rituximab 22 
number of HBV reactivation (+) 1 
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Disclosures:

No relevant conflicts of interest to declare.

Topics:
hepatitis b virus, lymphoma, hepatitis b core antibody, hepatitis b surface antigens, hepatitis b virus dna, rituximab, chemotherapy regimen, liver function tests, steroids, entecavir

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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