Hepatitis B screening, prophylaxis and re-activation in the era of rituximab-bas

StephenW

<http://www.ingentaconnect.com/content/mksg/liv/2011/00000031/00000003/art00009>

Hepatitis B screening, prophylaxis and re-activation in the era of
rituximab-based chemotherapy

Authors: Méndez-Navarro, Jorge; Corey, Kathleen E.1; Zheng, Hui2; Barlow, Lydia
L.1; Jang, Jae Young; Lin, Wenyu1; Zhao, Hong1; Shao, Run-Xuan1; McAfee, Steven
L.3; Chung, Raymond T.1

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

B型肝炎筛检，预防和重新激活的时代
利妥昔单抗为基础的化疗

作者：门德斯-纳瓦罗，豪，科里，凯瑟琳E.1节，郑，Hui2;巴洛，莉迪亚
L.1的;张，在荣，林，Wenyu1，赵，红1，邵，润Xuan1，迈克菲，史蒂芬
L.3号;骢T.1

来源：国际肝病，31卷，第3号，2011年3月，第330-339（10）
出版商：威利-布莱克韦尔

摘要：

背景：
乙型肝炎重新激活是一个良好的患者描述的并发症，
无效慢性乙型肝炎接受化疗。 HBV的筛选和
先发制人的治疗建议。然而，乙肝病毒筛检率，
美罗华期间预防和含化疗重新激活是
不明。

病人及方法：
我们进行非霍奇金回顾性研究的患者淋巴瘤（NHL）
谁1997年8月间收到的2009年9月美罗华。我们评估
乙型肝炎病人血清学，抗病毒和乙肝预防
重新激活期间或化疗后长达6个月。

结果：
一千四百二十九例
美罗华，含非霍奇金淋巴瘤化疗。乙型肝炎血清学了
记录在524（36.6％）患者。其中，20（3.8％）为乙肝表面抗原阳性和
10（50％）经历了乙肝病毒重新激活。只有一半（5 / 10）乙肝病毒血清学了
文件才重新激活。只有3 / 8例（37.5％）与新
乙肝表面抗原阳性收到文件抗病毒药物预防。病毒学
突破发生在治疗的慢性患者两个，三个一
关于预防和五分之二的病人没有接受非活动携带者
预防。重新激活再过5例患者不筛选
以前开发的B型肝炎病人一ALF和死亡。重新激活
并没有出现在25例患者分离出核心抗体阳性。

结论：
在三级医疗机构的乙肝血清学一些不常评估
美罗华前为基础的化疗和预防是少见。大
坚持筛选建议和预防是必要的。这
最理想的筛检率可能会降低，即使在社区医院，并可能
造成重大损害的屏蔽和unprophylaxed患者。

文件类型：研究论文
分类号：10.1111/j.1478-3231.2010.02332.x
背景：1：胃肠股，麻省总医院，哈佛
医学院，马萨诸塞州的波士顿，美国2：生物统计中心麻省总医院，哈佛医学院
学校，马萨诸塞州的波士顿，美国3：血液/肿瘤学，医学系，
马萨诸塞州总医院，哈佛医学院，波士顿，马萨诸塞，美国
出版日期：2011年3月1日