Table 5.
HBV surface antigen-positive rituximab-associated HBV reactivation: case series
| Author | NHL type | Received prophylaxis (lamivudine) | Concurrent immune suppressants | Incidence of rituximab-associated HBV reactivation (versus nonrituximab reactivation, if available) | Mortality |
| Tsutsumi et al. [53] | Mixed | 10/25 rituximab-based with prophylaxisa | Rituximab alone, rituximab/chemotherapy, chemotherapy alone (n = 47) | 20% (1/5) rituximab alone and 16% (3/20) rituximab/chemotherapy (versus 0/22 chemotherapy, P = 0.07) | NR |
| Wang et al. [54] | DLBCL | None | CHOP (n = 13) | 33% (13/40) rituximab/chemotherapy with hepatic dysfunction (versus 34% (14/41) chemotherapy) | NR |
| Hanbali et al. [50] | Mixed | None | Mixed (n = 6) | 65% (4/6) with acute liver eventsb and 30% (2/6) with liver failure | NR |
| Pei et al. [55] | Mixed | 5/15 received lamivudine | Mixed (n = 15) | 80% (12/15) with reactivationd | 17%c |
| Kusumoto et al. [52] | Mixed | NR | None/rituximab alone (n = 7), R-CHOP (n = 24), R-chemotherapy without steroids (n = 15) | NR (47 total pts with reactivation); 21% of pts with fulminant liver failure | 28% |
Zero of 10 HBV reactivation for pts with lamivudine prophylaxis versus 4/15 (27%) without antiviral prophylaxis.
Acute liver events defined by acute elevation of liver enzymes, abnormal liver biopsy diagnostic of hepatitis or liver necrosis, hepatic encephalopathy, or demonstration of active viral DNA replication by PCR.
One of 4 that received prophylaxis died versus 1/8 without prophylaxis.
dFour of 5 (80%) that received lamivudine with HBV reactivation versus 8/10 (80%) without prophylaxis with HBV reactivation.
NHL, non-Hodgkin's lymphoma; HBV Hepatitis B virus; DLBCL, diffuse large B-cell lymphoma; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; NR, not reported.