Follow-Up of Reactivation of HB Virus in HBV Antibody Positive Lymphoma After Chemotherapy in a Single Institution

Abstract

Reactivation of hepatitis B virus (HBV) in pts with HBV antibody positive lymphoma after chemo-immunotherapy became to be of great concern. According to the guideline, all pts should be screened for HBsAg. HB surface antibody and HB core antibody testing should be performed in HBsAg negative pts. Prophylaxis with nucleoside analogs(NA) is needed for preventing HBV reactivation in HBsAg positive pts. HBsAg negative with HBsAb and/or HBcAb positive pts should be monitored monthly for an increase in serum HBV DNA during and 12 months after completion of chemotherapy. NA should be administrated immediately when HBV-DNA becomes positive during this period.We retrospectively analyzed the incidence of HBV-DNA reactivation in HB antibody-positive lymphoma and the monitoring of HBV-DNA after chemoimmunotherapy in our institution. Between January 2007 and December 2012, 37 pts of lymphoma with HB antibody positive received chemotherapy. The chemotherapy including rituximab was carried out in 33 pts. The median follow-up duration was 15 months (3 - 69 months). The demography of 37 cases: 21 men and 16 women, the median age: 67 yrs (49-83 yrs old). Twenty pts had clinical stage IV. The pathology (WHO) was diffuse large B-cell lymphoma in 22 and others in 15. HBsAg positive for 5 and negative for 32 pts. All cases were HBcAb positive. Five HCV positive pts were included. For the HBsAg-positive pts preventive treatment of entecavir (ETV) was carried out in chemotherapy and were observed only grade 1 liver dysfunction according to the NCI-CTC for AE v.3 and the HBV-DNA level recognized negative conversion. In the HBsAg-negative 32 pts, HBV-DNA was increasingly detected in three patients at 12 - 28 months of follow-up, who were adequately monitored for HBV-DNA and successfully treated with ETV. dysfunction grade 1-2 appeared in 15 pts. Liver dysfunction grade 3 in one pt was recognized, which was considered to be participation of the HCV. The monitoring of HBV-DNA at the start of chemotherapy was improved. However, the rate of HBV-DNA monitoring every 1-2 months during chemotherapy and after was between 10 and 67{%}. Conclusion: the rate of HBV-DNA monitoring in the HBcAb-positive pts are still low despite the recommendation of guideline. It seems that the systemic management is necessary other than medical attendant instructions.