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Clin Infect Dis. 2015 Sep 1;61(5):719-29. doi: 10.1093/cid/civ344. Epub 2015 May 1.

Monitoring of Hepatitis B Virus (HBV) DNA and Risk of HBV Reactivation in B-Cell Lymphoma: A Prospective Observational Study.

Author information

1
Department of Hematology and Oncology.
2
Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences.
3
Department of Hematopoietic Stem Cell Transplantation Data Management and Biostatistics, Nagoya University Graduate School of Medicine.
4
Department of Hematology, National Cancer Center Hospital, Tokyo.
5
Department of Internal Medicine, Sapporo Hokuyu Hospital.
6
Department of Medical Oncology, Kanagawa Cancer Center, Yokohama.
7
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Saga University.
8
Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University.
9
Department of Hematology, Sasebo City General Hospital.
10
Divisions of Oncology and Hematology, National Cancer Center Hospital East, Kashiwa.
11
Department of Hematology and Infectious Diseases, Kumamoto University School of Medicine.
12
Division of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka.
13
Department of Hematology and Oncology, Anjo Kosei Hospital.
14
Department of Chemotherapy, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital.
15
Division of Hematology-Oncology, Chiba Cancer Center.
16
Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital.
17
Department of Hematology, National Hospital Organization Hokkaido Cancer Center, Sapporo.
18
Department of Hematology and Medical Oncology, Fujita Health University School of Medicine, Toyoake.
19
Department of Oncology/Hematology, Shimane University Hospital, Izumo.
20
Division of Hematology and Oncology, Toyohashi Municipal Hospital.
21
Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai.
22
Department of Hematology, International Medical Center, Saitama Medical University, Hidaka.
23
Department of Hematology, National Hospital Organization Nagasaki Medical Center, Ohmura.
24
Department of Hematology, Yokohama City University Medical Center.
25
Department of Hematology and Oncology, Tokai University School of Medicine, Isehara.
26
Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine.
27
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine.
28
Department of Medicine, Shinshu University School of Medicine, Matsumoto.
29
Department of Hematology and Oncology, Shiga Medical Center for Adults, Moriyama.
30
Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya.
31
The Research Center for Hepatitis and Immunology, National Center for Global Health and Medicine, Ichikawa.
32
Department of Tumor Immunology, Aichi Medical University School of Medicine, Japan.

Abstract

BACKGROUND:

There is no standard management of reactivation of hepatitis B virus (HBV) infection in HBV-resolved patients without hepatitis B surface antigen (HBsAg), but with antibodies against hepatitis B core antigen and/or antibodies against HBsAg (anti-HBs).

METHODS:

We conducted a prospective observational study to evaluate the occurrence of HBV reactivation by serial monthly monitoring of HBV DNA and to establish preemptive therapy guided by this monitoring in B-cell non-Hodgkin lymphoma (B-NHL) treated with rituximab plus corticosteroid-containing chemotherapy (R-steroid-chemo). The primary endpoint was the incidence of HBV reactivation defined as quantifiable HBV DNA levels of ≥ 11 IU/mL.

RESULTS:

With a median HBV DNA follow-up of 562 days, HBV reactivation was observed in 21 of the 269 analyzed patients. The incidence of HBV reactivation at 1.5 years was 8.3% (95% confidence interval, 5.5-12.4). No hepatitis due to HBV reactivation was observed in patients who received antiviral treatment when HBV DNA levels were between 11 and 432 IU/mL. An anti-HBs titer of <10 mIU/mL and detectable HBV DNA remaining below the level of quantification at baseline were independent risk factors for HBV reactivation (hazard ratio, 20.6 and 56.2, respectively; P < .001). Even in 6 patients with a rapid increase of HBV due to mutations, the monthly HBV DNA monitoring was effective at preventing HBV-related hepatitis.

CONCLUSIONS:

Monthly monitoring of HBV DNA is useful for preventing HBV reactivation-related hepatitis among B-NHL patients with resolved HBV infection following R-steroid-chemo (UMIN000001299).

KEYWORDS:

HBV DNA monitoring; HBV reactivation; preemptive antiviral therapy; resolved HBV infection; rituximab

PMID:
25935551
DOI:
10.1093/cid/civ344
[Indexed for MEDLINE]

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