High risk of clinical relapse in patients with chronic Hepatitis B virus infection after cessation of prophylactic antiviral therapy for rituximab-containing chemotherapy
Journal
Journal of Infectious Diseases
Journal Volume
222
Journal Issue
8
Pages
1345-1352
Date Issued
2020
Author(s)
Chiu Y.-C
Chiu F.-W
Hsu Y.-C
Cheng P.-N
Yang S.-S
Abstract
Background: Prophylaxis with nucleos(t)ide analogue (NA) is recommended to prevent hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients receiving rituximab-based B-cell depletion therapy. However, little is known about the risk of clinical relapse after withdrawal of NA. Methods: We retrospectively analyzed 77 noncirrhotic HBsAg carriers with hematological cancer who received rituximab-containing chemotherapy. All of them received either prophylactic entecavir or tenofovir therapy. The risk of clinical relapse and hepatic decompensation after cessation of NA was explored. Results: Clinical relapse and hepatic decompensation developed in 25 (32.5 %) and 11 (14.3 %) of the patients, respectively, and 2 patients died of hepatic decompensation. Most of the hepatic events occurred within 1 year (20 of 25; 80.0%) after stopping NA. A higher pretreatment viral load (?2000 vs <2000 IU/mL) was associated with increased risks of clinical relapse (hazard ratio, 3.47; 95% confidence interval, 1.56-7.73) and hepatic decompensation (9.91; 2.14-45.92). Of 51 patients with pretreatment viral load <2000 IU/mL, clinical relapse occurred in 10 (19.6 %) and hepatic decompensation in 2 (3.9%). Conclusions: Pretreatment HBV DNA ?2000 IU/mL is associated with increased risk of liver-related disease after cessation of prophylactic NA therapy in patients who received rituximab-containing chemotherapy. ? The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
SDGs
Other Subjects
entecavir; hepatitis B surface antigen; rituximab; tenofovir; virus DNA; antivirus agent; entecavir; guanine; hepatitis B surface antigen; immunological antineoplastic agent; rituximab; tenofovir; virus DNA; adult; antiviral therapy; Article; cancer chemotherapy; chronic hepatitis B; cohort analysis; decompensated liver cirrhosis; diffuse large B cell lymphoma; disease association; drug withdrawal; female; follicular lymphoma; high risk patient; human; incidence; infection prevention; infection risk; major clinical study; male; mantle cell lymphoma; middle aged; nonhuman; observational study; priority journal; recurrence risk; relapse; retrospective study; risk assessment; treatment duration; virus load; aged; blood; chronic hepatitis B; drug effect; hematologic disease; Hepatitis B virus; liver failure; recurrent disease; risk factor; treatment withdrawal; very elderly; virology; virus activation; young adult; Adult; Aged; Aged, 80 and over; Antineoplastic Agents, Immunological; Antiviral Agents; DNA, Viral; Female; Guanine; Hematologic Neoplasms; Hepatitis B Surface Antigens; Hepatitis B virus; Hepatitis B, Chronic; Humans; Liver Failure; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Rituximab; Tenofovir; Viral Load; Virus Activation; Withholding Treatment; Young Adult
Publisher
Oxford University Press
Type
journal article