Risk of hepatitis B virus (HBV) reactivation in non-Hodgkin lymphoma patients receiving rituximab-chemotherapy: A meta-analysis

American Gastroenterological Association Institute Technical Review on Prevention and Treatment of Hepatitis B Virus Reactivation During Immunosuppressive Drug Therapy

“…8 These drugs are used in a variety of disorders including leukemias, non-Hodgkins lymphoma, cryoglobulinemia, rheumatoid arthritis and idiopathic thrombocytopenic purpura. Frequent reporting of rituximab-associated HBVr has led to a recent expanded Box warning by the Food and Drug Administration in which it is strongly recommended that all patients who are to undergo B-cell depletion therapy be initially screened for HBV and if positive referred to a specialist to evaluate the need for antiviral prophylaxis or close monitoring.…”

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

“…The different frequency of cases with reactivation of occult HBV infection in different countries may explain, at least in part, the discordance in different national guidelines on lamivudine prophylaxis, some of which indicate the use of this nucleoside analogue for a pharmacological prophylaxis of HBsAg-negative/anti-HBc-positive patients undergoing highly immunosuppressive treatment for onco-hematological diseases [76] , and others conclude that the information available does not allow any routine prophylaxis to be recommended for these patients [77] . The data of a recent meta-analysis, however, suggest that rituximab-based chemotherapy increases the risk of HBV reactivation in HBsAg-negative/anti-HBc-positive patients with non-Hodgkin lymphoma [78] , an observation of clinical importance to be taken into consideration for future guidelines. [42] .…”

Diagnosis, Management, and Prevention of Hepatitis B Reactivation

“…A recent meta-analysis of 971 patients from 9 studies reported a relative risk of HBVr in isolated anti-HBc patients undergoing rituximab-based treatment for lymphoma of 5.52 (95 % CI 2.05-14.85, P=0.0007) [26].…”