Hepatitis B Reactivation with Rituximab Therapy for Lymphoma

Michael E. Williams, MD, ScM

Patients seropositive for hepatitis B core antibody had high rates of reactivation during or after rituximab-based regimens.

Hepatitis B virus (HBV) reactivation, at times associated with fulminant liver injury, is a well-recognized complication of rituximab therapy in lymphoma patients with prior infection. Investigators in China prospectively assessed the reactivation risk among patients receiving rituximab or rituximab-based chemotherapy who were positive for hepatitis B core antibody but negative for hepatitis B surface antigen.

A total of 63 patients were identified as core-antibody–positive only. None were receiving antiviral therapy, had detectable HBV DNA, or were positive for hepatitis C antibody. HBV and liver enzyme tests were performed every 4 weeks from the start of rituximab treatment.

The cumulative rates of HBV reactivation were 22.6% at 6 months, 29.3% at 1 year, and 41.5% at 2 years. About half of the patients reactivated during rituximab therapy, and the remainder reactivated after completion, with more frequent reactivation occurring among those negative for hepatitis B surface antibody. All patients achieved negativity for HBV DNA following entecavir treatment, and no liver failure was observed.

Citation(s):

Seto W-K et al. Hepatitis B reactivation in patients with previous hepatitis B virus exposure undergoing rituximab-containing chemotherapy for lymphoma: A prospective study. J Clin Oncol 2014 Oct 6; [e-pub ahead of print].