Background and Aims: Hepatitis B virus (HBV) reactivation can occur to 10–40% of lymphoma patients with ‘resolved’ HBV infection (HBsAg-negative and anti-HBc-positive) who received rituximab-based chemotherapy, but its impact on survival outcome was unclear. Methods: We prospectively followed 150 newly diagnosed lymphoma patients with resolved HBV infection who receive rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone)-based chemotherapy by regular HBV DNA monitoring. Patients withdocumented HBV reactivation, defined as a greater than 10-fold increase in HBV DNA compared with previous nadir levels, were treated with entecavir. Quantification of anti-HBc and anti-HBs levels at baseline was correlated with the risk of HBV reactivation and survival. Results: With a median follow-up of 46.0 months (range 1.1–63.9), patients who had HBV reactivation after rituximab-CHOPchemotherapy (n = 17) had worse survival than patients without(n = 133). The estimated 3-year overall survival rate was 52.3% (95% CI 50.2–54.4%) for patients with HBV reactivation and 78.2% (95% CI 72.3–84.1%) for those without (p = 0.033), and the 3-year progression-freesurvival rate was 46.3% (95% CI39.9–52.7%)vs. 72.9% (95% CI 69.6–76.3%) (p = 0.062). Thirty-eight patients died during follow-up. The major causes of death were tumor progression (18 patients), infection/sepsis (17 patients) and others(3 patients) and not significantly different between patients with or without HBV reactivation. Low anti-HBs and high anti-HBc levels at baseline predicted high risk of HBV reactivation. Conclusions: Chemotherapy-induced HBV reactivation was associated with worse survival in lymphoma patients with resolved HBV infection. Patients with low baseline anti-HBs and high anti-HBc levels may benefit most from prophylactic antiviral therapy.
Date:
2015-04
Relation:
Journal of Hepatology. 2015 Apr;62, Suppl. 2:S563.
