High Risk of Clinical Relapse in Patients With Chronic Hepatitis B Virus Infection After Cessation of Prophylactic Antiviral Therapy for Rituximab-Containing Chemotherapy.

Abstract

BACKGROUND:

Prophylaxis with nucleos(t)ide analogue (NA) is recommended to prevent hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients receiving rituximab-based B-cell depletion therapy. However, little is known about the risk of clinical relapse after withdrawal of NA.

METHODS:

We retrospectively analyzed 77 noncirrhotic HBsAg carriers with hematological cancer who received rituximab-containing chemotherapy. All of them received either prophylactic entecavir or tenofovir therapy. The risk of clinical relapse and hepatic decompensation after cessation of NA was explored.

RESULTS:

Clinical relapse and hepatic decompensation developed in 25 (32.5 %) and 11 (14.3 %) of the patients, respectively, and 2 patients died of hepatic decompensation. Most of the hepatic events occurred within 1 year (20 of 25; 80.0%) after stopping NA. A higher pretreatment viral load (≥2000 vs <2000 IU/mL) was associated with increased risks of clinical relapse (hazard ratio, 3.47; 95% confidence interval, 1.56-7.73) and hepatic decompensation (9.91; 2.14-45.92). Of 51 patients with pretreatment viral load <2000 IU/mL, clinical relapse occurred in 10 (19.6 %) and hepatic decompensation in 2 (3.9%).

CONCLUSIONS:

Pretreatment HBV DNA ≥2000 IU/mL is associated with increased risk of liver-related disease after cessation of prophylactic NA therapy in patients who received rituximab-containing chemotherapy.

• Authors: Wei-Yuan Chang, Yen-Cheng Chiu, Fang-Wei Chiu, Yao-Chun Hsu, Tai-Chung Tseng, Pin-Nan Cheng, Sheng-Shun Yang, Chun-Jen Liu, Tung-Hung Su, Hung-Chih Yang, Chen-Hua Liu, Pei-Jer Chen, Ding-Shinn Chen, Jia-Horng Kao
• Journal: The Journal of infectious diseases (J Infect Dis) Vol. 222 Issue 8 Pg. 1345-1352 (09 14 2020) ISSN: 1537-6613 [Electronic] United States
• PMID: 32396638 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Chemical References

• Antineoplastic Agents, Immunological
• Antiviral Agents
• DNA, Viral
• Hepatitis B Surface Antigens
• Rituximab
• entecavir
• Guanine
• Tenofovir

Topics

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Agents, Immunological (therapeutic use)
• Antiviral Agents (therapeutic use)
• DNA, Viral (blood)
• Female
• Guanine (analogs & derivatives, therapeutic use)
• Hematologic Neoplasms (drug therapy)
• Hepatitis B Surface Antigens (blood)
• Hepatitis B virus (drug effects)
• Hepatitis B, Chronic (drug therapy, prevention & control, virology)
• Humans
• Liver Failure (virology)
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Risk Factors
• Rituximab (therapeutic use)
• Tenofovir (therapeutic use)
• Viral Load
• Virus Activation (drug effects)
• Withholding Treatment
• Young Adult