Lamivudine prophylaxis prevents hepatitis B virus reactivation in anti-HBc positive patients under rituximab for non-Hodgkin lymphoma

Loglio, Alessandro; Viganò, Mauro; Grossi, G.; Labanca, Sara; Goldaniga, Maria; Pompa, Alessandra; Farina, Lucia; Rumi, M.G.; Corradini, Paolo; Facchetti, F.; Lunghi, G.; Baldini, Luca; Lampertico, Pietro

doi:10.1016/j.dld.2018.08.024

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…In another recent meta-analysis of three prospective studies of patients who received anti-CD20 monoclonal antibodies, the pooled estimated relative risk was 0.17, indicating a significantly lower risk of HBV reactivation in the antiviral prophylaxis group [20]. Finally, in a previous Italian study, only 1 of 85 patients with past HBV infection treated with R-CT and receiving prophylactic LAM showed a serum conversion of HBsAg [19].…”

Section: Introductionmentioning

confidence: 93%

“…Nevertheless, some authors still prefer to start pre-emptive NAT only if HBV reactivation is identified at an early stage by HBV DNA or HBsAg frequent monitoring [14,16,17]. In spite of this, randomized studies demonstrated that the risk of HBV reactivation under chemotherapy (CT) plus R ranges from 10.7% to 18% adopting the "pre-emptive strategy", compared to 0% and 2.4% using prophylaxis with LAM, TDF or ETV, respectively [9,18,19]. However, the use of LAM vs TDF/ETV in this setting remains debated.…”

Section: Introductionmentioning

confidence: 99%

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HBV Reactivation in Patients with Past Infection Affected by Non-Hodgkin Lymphoma and Treated with Anti-CD20 Antibody Based Immuno-Chemotherapy: A Multicenter Experience

Clerico

Dogliotti

Ghione

et al. 2022

JPM

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Hepatitis B virus reactivation (HBVr) can develop in HBV surface antigen (HBsAg) positive or HBsAg-negative and anti-hepatitis B core antigen antibodies (anti-HBc) positive (past HBV infection) patients receiving immuno-chemotherapy for hematological malignancies. A higher rate of HBVr is associated with the use of rituximab (R) in patients with past HBV infection, thus justifying an antiviral prophylaxis. In this study we evaluated the incidence of HBVr in a real-life cohort of 362 anti-HBc-positive subjects affected by non-Hodgkin lymphoma (NHL), mainly receiving lamivudine (LAM) prophylaxis (93%) and all undergoing a R-containing regimen. A retrospective, multicenter, observational study was conducted in 4 Italian Hematology Departments. The primary endpoint was the incidence of virologic (HBV DNA-positive), serologic (HBsAg-positive) and clinical (ALT increase > 3 × upper limit of normal) HBVr, which occurred in five, four and one patients, respectively, with a total HBVr rate of 1.4%. None of them had to discontinue the chemotherapy program, while two patients required a delay. Treatment-related adverse events (AEs) were reported during LAM prophylaxis in three patients (0.9%). In conclusion, this study confirms the efficacy and safety of LAM prophylaxis in anti-HBc-positive patients undergoing R-containing regimens.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

HBV Reactivation in Patients with Past Infection Affected by Non-Hodgkin Lymphoma and Treated with Anti-CD20 Antibody Based Immuno-Chemotherapy: A Multicenter Experience

Clerico

Dogliotti

Ghione

et al. 2022

JPM

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“…A meta-analysis involving 16 studies reported that the HBV-R rate was significantly lower in patients receiving LMV prophylaxis than in those of the control group (8.6% [11/127] vs. 50.6% [136/269], respectively), suggesting that LMV can reduce the incidence of HBV-R (relative risk [RR] 0.21, 95% CI 0.13-0.35), as well as HBV-related mortality (RR 0.68, 95% CI 0.19-2.49) (79). A recent retrospective study (80) on consecutively enrolled HBsAg(−) and HBcAb(+) NHL patients who received rituximab-based chemotherapy found that none of the patients who were given LMV prophylaxis experienced HBV-R or treatment-related side effects (81). However, the long-term use of LMV is liable to generate a high rate of drug resistance, especially when used beyond 1 year.…”

Section: Lamivudinementioning

confidence: 99%

HBV Reactivation During the Treatment of Non-Hodgkin Lymphoma and Management Strategies

Cao

Wang

et al. 2021

Front. Oncol.

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Hepatitis B virus reactivation (HBV-R), which can lead to HBV-related morbidity and mortality, is a common and well-known complication that occurs during the treatment of non-Hodgkin lymphoma (NHL) patients with current or past exposure to HBV infection. HBV-R is thought to be closely associated with chemotherapeutic or immunosuppressive therapies. However, immunosuppressive agents such as anti-CD20 antibodies (e.g., rituximab and ofatumumab), glucocorticoids, and hematopoietic stem cell transplantation (HSCT) administered to NHL patients during treatment can cause deep immunodepression and place them at high risk of HBV-R. In this review, we explore the current evidence, the guidelines of several national and international organizations, and the recommendations of expert panels relating to the definition, risk factors, screening and monitoring strategies, whether to use prophylaxis or pre-emptive therapy, and the optimal antiviral agent and duration of antiviral therapy for HBV-R.

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“…Prophylaxis with LAM is also indicated to prevent HBVr among pOBI at high risk of reactivation (≥10%) and/or with detectable HBVDNA at baseline; this strategy should ideally be applied 2–4 weeks before immunochemotherapy initiation if time and clinical needs allow [34,53,54,78,80]. Recent studies conducted in Italy added further evidence to recommend the use of prophylaxis among pOBI patients at high risk of HBVr [81,82]. The use of third generation antivirals in pOBI is on the contrary questionable and debated.…”

Section: Management Of Patients With Hm and Serological Signs Of Cmentioning

confidence: 99%

Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management

Zannella

Marignani

Begini

2019

Viruses

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It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.

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Lamivudine prophylaxis prevents hepatitis B virus reactivation in anti-HBc positive patients under rituximab for non-Hodgkin lymphoma

Cited by 12 publications

References 24 publications

HBV Reactivation in Patients with Past Infection Affected by Non-Hodgkin Lymphoma and Treated with Anti-CD20 Antibody Based Immuno-Chemotherapy: A Multicenter Experience

HBV Reactivation in Patients with Past Infection Affected by Non-Hodgkin Lymphoma and Treated with Anti-CD20 Antibody Based Immuno-Chemotherapy: A Multicenter Experience

HBV Reactivation During the Treatment of Non-Hodgkin Lymphoma and Management Strategies

Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management

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