Hepatitis B Virus Reactivation in Lymphoma Patients With Prior Resolved Hepatitis B Undergoing Anticancer Therapy With or Without Rituximab
Hepatitis B Virus Reactivation in Lymphoma Patients With Prior Resolved Hepatitis B Undergoing Anticancer Therapy With or Without Rituximab
复制标题
DOI：
10.1200/jco.2008.18.0182
复制
发表时间：
2009-02-01
影响因子：
45.3
通讯作者：
Chan, Paul K. S.
中科院分区：
文献类型：
--
作者：
Yeo, Winnie;Chan, Tung C.;Chan, Paul K. S.
目的乙型肝炎病毒 (HBV) 感染的再激活是接受细胞毒性化疗的慢性 HBV（乙型肝炎表面抗原 [HBsAg] 阳性）癌症患者的一种公认的并发症。在已治愈 HBV 的患者中（HBsAg 阴性且乙型肝炎核心抗原抗体 [抗 HBc] +/- 乙型肝炎表面抗原抗体 [抗 HBs] 阳性），这种情况的发生率要低得多，直到最近使用利妥昔单抗。在这项针对 HBsAg 阴性/抗 HBc 阳性淋巴瘤患者的研究中，目的是确定接受含利妥昔单抗化疗的患者的 HBV 再激活率，并将其与未接受利妥昔单抗治疗的患者进行比较。 患者和方法 2003 年 1 月至 2006 年 12 月期间，所有诊断为 CD20(+) 弥漫性大 B 细胞淋巴瘤 (DLBCL) 的患者在抗癌治疗前均进行了 HBsAg 测定。他们单独接受环磷酰胺、阿霉素、长春新碱和泼尼松 (CHOP) 治疗，或接受利妥昔单抗加 CHOP (R-CHOP) 治疗。 HBsAg 阴性患者进行了抗 HBc 测定；储存血清用于抗 HBs 和 HBV DNA。观察所有患者的HBV再激活情况，即抗癌治疗期间和治疗后6个月内可检测到的HBV DNA伴ALT升高。结果在104例CD20(+) DLBCL患者中，80例HBsAg阴性。其中，46 名患者 (44.2%) HBsAg 阴性/抗 HBc 阳性；其中 25 名患者接受了 CHOP 治疗，没有人出现 HBV 再激活。相比之下，在接受 R-CHOP 治疗的 21 名患者中，有 5 名出现 HBV 再激活，其中一名患者死于肝衰竭 (P = .0148)。探索性分析确定男性、缺乏抗 HBs 以及使用利妥昔单抗可预测 HBV 再激活。 结论 在接受 R-CHOP 治疗的 HBsAg 阴性/抗 HBc 阳性 DLBCL 患者中，25% 出现 HBV 再激活。需要在抗癌治疗后至少 6 个月进行密切监测，并采用预防性抗病毒治疗的替代方法来预防这种潜在的致命疾病。
PurposeReactivation of hepatitis B virus (HBV) infection is a well-recognized complication in cancer patients with chronic HBV (hepatitis B surface antigen [HBsAg] positive) undergoing cytotoxic chemotherapy. In patients who have resolved HBV (HBsAg negative and antibody to hepatitis B core antigen [anti-HBc] +/- antibody to hepatitis B surface antigen [anti-HBs] positive), such incidence has been much less common until recent use of rituximab. In this study on HBsAg-negative/anti-HBc-positive lymphoma patients, the objectives were to determine the HBV reactivation rate in patients treated with rituximab-containing chemotherapy and to compare it with the rate in patients treated without rituximab.Patients and MethodsBetween January 2003 and December 2006, all patients diagnosed with CD20(+) diffuse large B-cell lymphoma (DLBCL) had HBsAg determined before anticancer therapy. They were treated with either cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) alone or rituximab plus CHOP (R-CHOP). HBsAg-negative patients had anti-HBc determined; serum was stored for anti-HBs and HBV DNA. All patients were observed for HBV reactivation, which was defined as detectable HBV DNA with ALT elevation during and for 6 months after anticancer therapy.ResultsAmong 104 CD20(+) DLBCL patients, 80 were HBsAg negative. Of the latter, 46 patients (44.2%) were HBsAg negative/anti-HBc positive; 25 of these patients were treated with CHOP, and none had HBV reactivation. In contrast, among the 21 patients treated with R-CHOP, five developed HBV reactivation, including one patient who died of hepatic failure (P = .0148). Exploratory analysis identified male sex, absence of anti-HBs, and use of rituximab to be predictive of HBV reactivation.ConclusionAmong HBsAg-negative/anti-HBc-positive DLBCL patients treated with R-CHOP, 25% developed HBV reactivation. Close monitoring until at least 6 months after anticancer therapy is required, with an alternative approach of prophylactic antiviral therapy to prevent this potentially fatal condition.