HBV monitoring key for lymphoma patients with resolved hepatitis

Research suggests monthly monitoring of viral DNA may help prevent reactivation-related hepatitis in some B-cell non-Hodgkin’s lymphoma patients who have had hepatitis B.

“HBV reactivation has been reported as a potentially fatal complication in B-cell non-Hodgkin’s lymphoma patients with resolved HBV infection who received anti-CD20 antibody, rituximab plus corticosteroid-containing chemotherapy (R-steroid-chemotherapy),” Shigeru Kusumoto, MD, PhD, of the department of hematology and oncology, Nagoya City University Graduate School of Medical Sciences, Japan, and colleagues wrote in Clinical Infectious Diseases. “For the patients with resolved HBV infection, no standard strategy has yet been established to prevent HBV reactivation.”

The study, conducted from September 2008 through July 2011, included 269 patients with previously untreated CD20-positive B-cell non-Hodgkin’s lymphoma (B-NHL) who were seronegative for hepatitis B surface antigen (HBsAg) and seropositive for hepatitis B core antigen (anti-HBc) and/or antibodies to HBsAg (anti-HBs). All patients were scheduled for six to eight cycles of R-steroid-chemotherapy, and none had a history of vaccination for HBV.

The researchers established baseline HBV status according to serological results for HBsAg, antibody to anti-HBc, and anti-HBs. Plasma HBV DNA levels were determined by real-time PCR assay.

If baseline HBV DNA levels of less than 11 IU/mL were confirmed, regular monitoring and assessment of HBV DNA were performed every 4 weeks after enrollment for 18 months, according to the researchers. Nearly 83% of patients completed the monitoring process, and four additional patients continued beyond that time period. The remaining 15.6% of patients discontinued monitoring for various reasons, including lymphoma progression.

Twenty-two patients had HBV reactivation (77% male; median age, 69), with the median HBV DNA level at reactivation 27 IU/mL. HBV reactivation levels ranged from 11 IU/mL to 432 IU/mL, Kusumoto and colleagues wrote. Treatment with Baraclude (entecavir, Bristol-Myers Squibb), at 0.5 mg per day, was highly recommended.

Prompt antiviral treatment pushed HBV DNA levels below the detection limit at the first two measurements after antiviral treatment initiation, with no further reactivation over the treatment period. The median antiviral treatment period was 647 days.

“Pre-emptive antiviral therapy, timed depending on monthly HBV DNA monitoring using a cut-off value of 11 IU/mL, was effective at preventing hepatitis in all patients with HBV reactivation,” the researchers concluded. – by David Jwanier

Disclosure: Kusumoto reports receiving research funding from Chugai Pharmaceutical and honoraria from Chugai Pharmaceutical, Zenyaku Kogyo, Bristol-Myers Squibb and Abbott. Please see the full study for a list of all other authors’ relevant financial disclosures.