RITUXIMAB-ASSOCIATED HEPATITIS B VIRUS (HBV) REACTIVATION IN LYMPHOPROLIFERATIVE DISEASES : CASE REPORTS
(Abstract release date: 05/21/15)
EHA Library. Bougherira S. 06/12/15; 102843; PB1804
Disclosure(s): faculty of medecine, university hospital of Annabahematology
Soraya Bougherira
Contributions
Contributions
Abstract
Abstract: PB1804
Type: Publication Only
Background
Reactivation of hepatitis B virus (HBV) after rituximab-based chemotherapy regimens in patients with B chronic lymphoproliferative disorders is well-recognized as a potentially serious complication in HBV immune patients. It has been observed in patients positive for hepatitis B surface antigen (HBsAg) and in HBsAg negative patients who had HBV infection in the past. The risk of HBV reactivation differs according to both the patient’s HBV infection status prior to systemic chemotherapy and the degree of immunosuppression due to chemotherapy. The overall incidence of reactivation with use of rituximab is unclear, but ranges from 2% to 35% of patients.
Aims
To discuss the relationship between Rituximab-based therapy and B hepatitis reactivation, and to estabilish the management of hepatitis associated with the use of Rituximab, prevention and treatment.
Methods
We conducted a prospective study on nine patients with lymphoproliferive diseases, whom treated with Rituximab, in our institution from 2013 to 2014. Data were collected and analysed from medical records. We were focused on risk factors for HBV reactivation, clinical characteristics, biological data and management. Lymphoproliferative histologies were diffuse large B-cell lymphoma (n = 3), follicular lymphoma(n=1) CLL (n = 2), mantle-cell lymphoma (n = 1), and marginal zone lymphoma (n=2). All patients received Rituximab-containig chemotherapy: FCR (Fludarabine, Cyclophosphamide, Rituximab), and R-CHOP (Rituximab - Cyclophosphamide, Doxorubicine, Vincristine and Prednisone). Four patients were HBV positve ; one of them was treated by pegylated Interferon and was completely recovered before starting Rituximab.
Results
The median age at diagnosis was 56 years (rang 37-72), and seven patients were male. HBV screening data were available for all patients at baseline. 4 patients were HBsAg positive, five of them were HBsAg negative. The time from last rituximab to reactivation was 3 months (range 0–12), HBV reactivation occured usually at the completion of chemotherapy (upper than 3 months after the last dose of Rituximab), for 3 patients in the periods between cycles (median occurrence was 17 days). Clinical manifestations of hepatitis B reactivation were variable and ranged from asymptomatic to acute hepatitis (2 patients). Serum transaminase (ALT, AST) levels were elevated, high total bilirubin and hepatitis serology tests revealed reappearance of HBsAg and hepatitis B e antigen (HBeAg), loss of anti-HBsAb, and positivity for hepatitis B virus (HBV) DNA (3 patients were HBV DNA negative). Lamivudine and entecavir (nucleoside analogues) were the most antiviral used for the treatment of HBV reactivation. Six patients were treated : 05 of them received Lamuvidine schudeled at 100 mg daily. Entecavir was prescribed for one patient who received previously Interferon. The remaining 3 (33% patients) were HBsAg negative and anti-HBsAb negative and anti-HBcAb positive, did not undego treatment and they were closely monitored for HBsAg, anti-HBsAb, HBV-DNA, and transaminase levels. The hepatitis flare was controlled (improvement of liver function tests, reduction of HBV DNA levels) and treatment was well tolerated. At the last follow-up, two patients died because of fulminant hepatitis and severe peumonia
Summary
Rituximab-based therapy may cause serious HBV-related complications and even death, by increasing the risk of HBV reactivation both in inactive carriers and those with resolved HBV. Baseline HBV serology is recommended for all patients receiving immuno-chemotherapy regimen, and HBsAg positive patients should receive anti-HBV prophylaxis to decrease virus reactivation and death rates.
Keyword(s): Hepatitis B virus, Lymphoproliferative disorder
Session topic: Publication Only
Type: Publication Only
Background
Reactivation of hepatitis B virus (HBV) after rituximab-based chemotherapy regimens in patients with B chronic lymphoproliferative disorders is well-recognized as a potentially serious complication in HBV immune patients. It has been observed in patients positive for hepatitis B surface antigen (HBsAg) and in HBsAg negative patients who had HBV infection in the past. The risk of HBV reactivation differs according to both the patient’s HBV infection status prior to systemic chemotherapy and the degree of immunosuppression due to chemotherapy. The overall incidence of reactivation with use of rituximab is unclear, but ranges from 2% to 35% of patients.
Aims
To discuss the relationship between Rituximab-based therapy and B hepatitis reactivation, and to estabilish the management of hepatitis associated with the use of Rituximab, prevention and treatment.
Methods
We conducted a prospective study on nine patients with lymphoproliferive diseases, whom treated with Rituximab, in our institution from 2013 to 2014. Data were collected and analysed from medical records. We were focused on risk factors for HBV reactivation, clinical characteristics, biological data and management. Lymphoproliferative histologies were diffuse large B-cell lymphoma (n = 3), follicular lymphoma(n=1) CLL (n = 2), mantle-cell lymphoma (n = 1), and marginal zone lymphoma (n=2). All patients received Rituximab-containig chemotherapy: FCR (Fludarabine, Cyclophosphamide, Rituximab), and R-CHOP (Rituximab - Cyclophosphamide, Doxorubicine, Vincristine and Prednisone). Four patients were HBV positve ; one of them was treated by pegylated Interferon and was completely recovered before starting Rituximab.
Results
The median age at diagnosis was 56 years (rang 37-72), and seven patients were male. HBV screening data were available for all patients at baseline. 4 patients were HBsAg positive, five of them were HBsAg negative. The time from last rituximab to reactivation was 3 months (range 0–12), HBV reactivation occured usually at the completion of chemotherapy (upper than 3 months after the last dose of Rituximab), for 3 patients in the periods between cycles (median occurrence was 17 days). Clinical manifestations of hepatitis B reactivation were variable and ranged from asymptomatic to acute hepatitis (2 patients). Serum transaminase (ALT, AST) levels were elevated, high total bilirubin and hepatitis serology tests revealed reappearance of HBsAg and hepatitis B e antigen (HBeAg), loss of anti-HBsAb, and positivity for hepatitis B virus (HBV) DNA (3 patients were HBV DNA negative). Lamivudine and entecavir (nucleoside analogues) were the most antiviral used for the treatment of HBV reactivation. Six patients were treated : 05 of them received Lamuvidine schudeled at 100 mg daily. Entecavir was prescribed for one patient who received previously Interferon. The remaining 3 (33% patients) were HBsAg negative and anti-HBsAb negative and anti-HBcAb positive, did not undego treatment and they were closely monitored for HBsAg, anti-HBsAb, HBV-DNA, and transaminase levels. The hepatitis flare was controlled (improvement of liver function tests, reduction of HBV DNA levels) and treatment was well tolerated. At the last follow-up, two patients died because of fulminant hepatitis and severe peumonia
Summary
Rituximab-based therapy may cause serious HBV-related complications and even death, by increasing the risk of HBV reactivation both in inactive carriers and those with resolved HBV. Baseline HBV serology is recommended for all patients receiving immuno-chemotherapy regimen, and HBsAg positive patients should receive anti-HBV prophylaxis to decrease virus reactivation and death rates.
Keyword(s): Hepatitis B virus, Lymphoproliferative disorder
Session topic: Publication Only
Abstract: PB1804
Type: Publication Only
Background
Reactivation of hepatitis B virus (HBV) after rituximab-based chemotherapy regimens in patients with B chronic lymphoproliferative disorders is well-recognized as a potentially serious complication in HBV immune patients. It has been observed in patients positive for hepatitis B surface antigen (HBsAg) and in HBsAg negative patients who had HBV infection in the past. The risk of HBV reactivation differs according to both the patient’s HBV infection status prior to systemic chemotherapy and the degree of immunosuppression due to chemotherapy. The overall incidence of reactivation with use of rituximab is unclear, but ranges from 2% to 35% of patients.
Aims
To discuss the relationship between Rituximab-based therapy and B hepatitis reactivation, and to estabilish the management of hepatitis associated with the use of Rituximab, prevention and treatment.
Methods
We conducted a prospective study on nine patients with lymphoproliferive diseases, whom treated with Rituximab, in our institution from 2013 to 2014. Data were collected and analysed from medical records. We were focused on risk factors for HBV reactivation, clinical characteristics, biological data and management. Lymphoproliferative histologies were diffuse large B-cell lymphoma (n = 3), follicular lymphoma(n=1) CLL (n = 2), mantle-cell lymphoma (n = 1), and marginal zone lymphoma (n=2). All patients received Rituximab-containig chemotherapy: FCR (Fludarabine, Cyclophosphamide, Rituximab), and R-CHOP (Rituximab - Cyclophosphamide, Doxorubicine, Vincristine and Prednisone). Four patients were HBV positve ; one of them was treated by pegylated Interferon and was completely recovered before starting Rituximab.
Results
The median age at diagnosis was 56 years (rang 37-72), and seven patients were male. HBV screening data were available for all patients at baseline. 4 patients were HBsAg positive, five of them were HBsAg negative. The time from last rituximab to reactivation was 3 months (range 0–12), HBV reactivation occured usually at the completion of chemotherapy (upper than 3 months after the last dose of Rituximab), for 3 patients in the periods between cycles (median occurrence was 17 days). Clinical manifestations of hepatitis B reactivation were variable and ranged from asymptomatic to acute hepatitis (2 patients). Serum transaminase (ALT, AST) levels were elevated, high total bilirubin and hepatitis serology tests revealed reappearance of HBsAg and hepatitis B e antigen (HBeAg), loss of anti-HBsAb, and positivity for hepatitis B virus (HBV) DNA (3 patients were HBV DNA negative). Lamivudine and entecavir (nucleoside analogues) were the most antiviral used for the treatment of HBV reactivation. Six patients were treated : 05 of them received Lamuvidine schudeled at 100 mg daily. Entecavir was prescribed for one patient who received previously Interferon. The remaining 3 (33% patients) were HBsAg negative and anti-HBsAb negative and anti-HBcAb positive, did not undego treatment and they were closely monitored for HBsAg, anti-HBsAb, HBV-DNA, and transaminase levels. The hepatitis flare was controlled (improvement of liver function tests, reduction of HBV DNA levels) and treatment was well tolerated. At the last follow-up, two patients died because of fulminant hepatitis and severe peumonia
Summary
Rituximab-based therapy may cause serious HBV-related complications and even death, by increasing the risk of HBV reactivation both in inactive carriers and those with resolved HBV. Baseline HBV serology is recommended for all patients receiving immuno-chemotherapy regimen, and HBsAg positive patients should receive anti-HBV prophylaxis to decrease virus reactivation and death rates.
Keyword(s): Hepatitis B virus, Lymphoproliferative disorder
Session topic: Publication Only
Type: Publication Only
Background
Reactivation of hepatitis B virus (HBV) after rituximab-based chemotherapy regimens in patients with B chronic lymphoproliferative disorders is well-recognized as a potentially serious complication in HBV immune patients. It has been observed in patients positive for hepatitis B surface antigen (HBsAg) and in HBsAg negative patients who had HBV infection in the past. The risk of HBV reactivation differs according to both the patient’s HBV infection status prior to systemic chemotherapy and the degree of immunosuppression due to chemotherapy. The overall incidence of reactivation with use of rituximab is unclear, but ranges from 2% to 35% of patients.
Aims
To discuss the relationship between Rituximab-based therapy and B hepatitis reactivation, and to estabilish the management of hepatitis associated with the use of Rituximab, prevention and treatment.
Methods
We conducted a prospective study on nine patients with lymphoproliferive diseases, whom treated with Rituximab, in our institution from 2013 to 2014. Data were collected and analysed from medical records. We were focused on risk factors for HBV reactivation, clinical characteristics, biological data and management. Lymphoproliferative histologies were diffuse large B-cell lymphoma (n = 3), follicular lymphoma(n=1) CLL (n = 2), mantle-cell lymphoma (n = 1), and marginal zone lymphoma (n=2). All patients received Rituximab-containig chemotherapy: FCR (Fludarabine, Cyclophosphamide, Rituximab), and R-CHOP (Rituximab - Cyclophosphamide, Doxorubicine, Vincristine and Prednisone). Four patients were HBV positve ; one of them was treated by pegylated Interferon and was completely recovered before starting Rituximab.
Results
The median age at diagnosis was 56 years (rang 37-72), and seven patients were male. HBV screening data were available for all patients at baseline. 4 patients were HBsAg positive, five of them were HBsAg negative. The time from last rituximab to reactivation was 3 months (range 0–12), HBV reactivation occured usually at the completion of chemotherapy (upper than 3 months after the last dose of Rituximab), for 3 patients in the periods between cycles (median occurrence was 17 days). Clinical manifestations of hepatitis B reactivation were variable and ranged from asymptomatic to acute hepatitis (2 patients). Serum transaminase (ALT, AST) levels were elevated, high total bilirubin and hepatitis serology tests revealed reappearance of HBsAg and hepatitis B e antigen (HBeAg), loss of anti-HBsAb, and positivity for hepatitis B virus (HBV) DNA (3 patients were HBV DNA negative). Lamivudine and entecavir (nucleoside analogues) were the most antiviral used for the treatment of HBV reactivation. Six patients were treated : 05 of them received Lamuvidine schudeled at 100 mg daily. Entecavir was prescribed for one patient who received previously Interferon. The remaining 3 (33% patients) were HBsAg negative and anti-HBsAb negative and anti-HBcAb positive, did not undego treatment and they were closely monitored for HBsAg, anti-HBsAb, HBV-DNA, and transaminase levels. The hepatitis flare was controlled (improvement of liver function tests, reduction of HBV DNA levels) and treatment was well tolerated. At the last follow-up, two patients died because of fulminant hepatitis and severe peumonia
Summary
Rituximab-based therapy may cause serious HBV-related complications and even death, by increasing the risk of HBV reactivation both in inactive carriers and those with resolved HBV. Baseline HBV serology is recommended for all patients receiving immuno-chemotherapy regimen, and HBsAg positive patients should receive anti-HBV prophylaxis to decrease virus reactivation and death rates.
Keyword(s): Hepatitis B virus, Lymphoproliferative disorder
Session topic: Publication Only
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