Hepatitis B Reactivation and Rituximab in the Oncology Practice

Abstract

After completing this course, the reader will be able to:1. Perform screening for prior hepatitis B viral exposure in all patients with hematologic malignancies who will receive rituximab as part of their therapy.2. Implement prophylactic antiviral therapy in patients who are positive for hepatitis B and who are being treated with rituximab.3. Monitor serum viral load and clinical signs of hepatic injury for at least six months following the completion of rituximab treatment in patients who are hepatitis B-sAg positive.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTRituximab use in hematology and oncology practice has significantly and positively improved the clinical outcomes in patients with a wide variety of B-cell lymphoproliferative disorders. However, emerging data reveal that there is a risk of viral hepatitis B reactivation in some patients treated with rituximab. Many of these cases result in treatment delays, inferior oncologic outcomes, increased morbidity, and more rarely fulminant hepatic decompensation and death. Indeed, the rituximab package insert and many clinical practice guidelines have been modified to reflect these concerns. The true incidence and mechanism of reactivation are still being elucidated. This article focuses on the current evidence that supports these recently re-

Patients with hematological malignancies and serological signs of prior resolved hepatitis B

“…Reactivation in HM patients can have severe consequences, such as hepatitis flare, hepatic failure and even death [4,9] . Reactivation in HM patients can also lead to delays or interruption of curative CHT, resulting in a decreased disease free and overall survival [10] .…”

Stopping Preemptive Antiviral Therapy for Hepatitis B Virus Can Be Considered for Patients with Favorable Predictors

“…Rituximab is a well-known risk factor for virological relapse and biochemical flare [15,16]. In this study, rituximab use showed marginal association with SOVR in univariate analysis and was the only factor associated with biochemical flare, indicating that special attention is needed for patients who used rituximab, while considering NUC discontinuation.…”

Hepatitis B Reactivation in Immunosupressed Patients, Prophylaxis and Management

“…The rate of hepatitis B virus reactivation during rituximab treatment when combined with chemotherapy has been reported to be 20-55% overall and 3% in patients with negative HbsAg. 10,11 due to various chemotherapeutic/ immunosuppressive agents are shown in Table 2 and Figure 3.…”