标题: Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-bas [打印本页] 作者: StephenW 时间: 2011-2-10 00:43 标题: Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-bas
Source: Liver International, Volume 31, Number 3, March 2011 , pp. 330-339(10)
Publisher: Wiley-Blackwell
Abstract:
Background:
Hepatitis B re-activation is a well-described complication in patients with
inactive chronic hepatitis B receiving chemotherapy. Screening for HBV and
pre-emptive therapy are recommended. However, the rates of HBV screening,
prophylaxis and re-activation during rituximab-containing chemotherapy are
unknown.
Patients and methods:
We performed a retrospective study of patients with non-Hodgkin lymphoma (NHL)
who received rituximab between August 1997 and September 2009. We evaluated
patients for hepatitis B serologies, antiviral prophylaxis and hepatitis B
re-activation during or up to 6 months after chemotherapy.
Results:
One thousand four hundred and twenty-nine patients underwent
rituximab-containing chemotherapy for NHL. Hepatitis B serologies were
documented in 524 (36.6%) patients. Of these, 20 (3.8%) were HBsAg positive and
10 (50%) experienced HBV re-activation. Only half (5/10) had HBV serology
documented before re-activation. Only 3/8 (37.5%) of patients with newly
documented HBsAg positivity received antiviral prophylaxis. Virological
breakthrough occurred in two of the patients on chronic therapy, in one of three
inactive carriers on prophylaxis and in two of five patients not receiving
prophylaxis. Re-activation developed in another five patients not screened
previously for hepatitis B. One patient developed ALF and died. Re-activation
did not occur in 25 patients with isolated positive core antibody.
Conclusions:
At tertiary care institutions hepatitis B serologies are infrequently assessed
before rituximab-based chemotherapy and prophylaxis is uncommon. Greater
adherence to recommendations for screening and prophylaxis is necessary. This
suboptimal screening rate could be even lower in community hospitals and could
result in significant harm to unscreened and unprophylaxed patients.
Document Type: Research article
DOI: 10.1111/j.1478-3231.2010.02332.x
Affiliations: 1: Gastrointestinal Unit, Massachusetts General Hospital, Harvard
Medical School, Boston, MA, USA 2: MGH Biostatistics Center, Harvard Medical
School, Boston, MA, USA 3: Hematology/Oncology, Department of Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
Publication date: 2011-03-01