Hepatitis B virus reactivation after withdrawal of prophylactic antiviral therapy in patients with diffuse large B cell lymphoma

Abstract

The exact incidence and severity of hepatitis B virus (HBV) reactivation after the withdrawal of prophylactic antiviral therapy (delayed HBV reactivation) is unknown. We retrospectively analyzed 107 newly diagnosed diffuse large B cell lymphoma patients with HBV infection who received chemotherapy. The median time from the cessation of antitumor therapy to the withdrawal of prophylactic antiviral therapy was 6.1 months. The incidence of delayed HBV reactivation was 21.7% in HBsAg-positive group and 0 in HBsAg-negative/anti-HBc-positive group (P < 0.001). No HBV-related fulminant hepatitis or hepatitis-related death occurred. The multivariate analysis showed that female gender and lengthy cycles of chemotherapy (>8 cycles) were independent risk factors of HBV reactivation in HBsAg-positive patients. In conclusion, prophylactic antiviral therapy could be withdrawn 6 months after the cessation of chemotherapy in HBsAg-negative/anti-HBc-positive patients. However, a longer course of prophylactic antiviral drug administration may be an optimal option to prevent delayed HBV reactivation for HBsAg-positive patients.

Hepatitis B virus reactivation in patients with rheumatoid arthritis: Analysis of the National Database of Japan

“…The results of previous studies regarding the effect of age on reactivation seem to be controversial. While some reported that age was not to be associated with reactivation, 5,9,26,29,30 one study reported a higher risk, 15 and another reported a lower risk. 31 Further studies are therefore needed.…”

Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance

“…The most commonly studied and recommended duration of prophylactic antiviral therapy is 6‐12 months after discontinuation of anticancer therapy or immunosuppression. Reactivation beyond 12 months has been reported, so further monitoring should be considered, particularly for patients who received anti‐CD20 antibody therapy . Much less is known about the optimal duration of prophylaxis in patients receiving chronic immunosuppression, for example, transplantation and biological therapy …”

“…Reactivation beyond 12 months has been reported, so further monitoring should be considered, particularly for patients who received anti-CD20 antibody therapy. (208)(209)(210) Much less is known about the optimal duration of prophylaxis in patients receiving chronic immunosuppression, for example, transplantation and biological therapy. (182,(211)(212)(213)(214) Guidance Statements for Patients Undergoing Immunosuppressive and Cytotoxic Therapy 1.…”

Prevention and management of viral hepatitis in inflammatory bowel disease: a clinical practice guideline by the Korean Association for the Study of Intestinal Diseases

“…98,[107][108][109] The antiviral prophylaxis is recommended to be administered 6 to 12 months after discontinuation of immunosuppression, 107 as HBV reactivation beyond 12 months reported, particularly in patients who received rituximab (anti-CD20 antibody). [110][111][112]…”