High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy

Roberto Castelli, Laurenzia Ferraris, Giuseppe Pantaleo, Giorgio Lambertenghi Deliliers, Marco Cicardi

Research output: Contribution to journalArticle

Abstract

Background Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with “resolved” HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression. Viral breakthrough occurs with non-compliance to therapy and, also, when drug-resistant mutants emerge. The risk might be higher in fragile patients as elderlies. Aims Since no study addressed this question, we determined the rate of HBV-RS in patients >65 years undergoing Rituximab-containing chemotherapies for NHLs. Methods We evaluated 85 newly diagnosed NHL patients with resolved HBV infection, receiving Rituximab-containing chemotherapies. All received lamivudine. HBV DNA was checked at baseline, every 4 weeks, for 1 year after completion of Rituximab cointaining regimens. Results Nine patients (10%) had HBV reactivation and HBV related hepatitis. All received entecavir and recovered without consequences. HBV reactivation was more likely to occur after an average of five R-CHOP cycles or during Fludarabine. Conclusions The rate of viral breakthrough (VBK), in our study population, is high considering that the patients were HBV DNA negative at baseline and suggest that Lamivudine prevention may not be sufficient in this population.

Original languageEnglish
Pages (from-to)1394-1397
Number of pages4
JournalDigestive and Liver Disease
Volume48
Issue number11
DOIs
Publication statusPublished - Nov 1 2016

Fingerprint

Hepatitis B
Non-Hodgkin's Lymphoma
Drug Therapy
Lamivudine
Tenofovir
Hepatitis
DNA
Infection
Rituximab
Population
Antiviral Agents
Therapeutics
Serum
Pharmaceutical Preparations

Keywords

  • Elderlies
  • HBV reactivation
  • Non-Hodgkin lymphomas (NHLs)
  • Rituximab-containing chemotherapies

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy. / Castelli, Roberto; Ferraris, Laurenzia; Pantaleo, Giuseppe; Lambertenghi Deliliers, Giorgio; Cicardi, Marco.

In: Digestive and Liver Disease, Vol. 48, No. 11, 01.11.2016, p. 1394-1397.

Research output: Contribution to journalArticle

Castelli, Roberto ; Ferraris, Laurenzia ; Pantaleo, Giuseppe ; Lambertenghi Deliliers, Giorgio ; Cicardi, Marco. / High rate of hepatitis B viral breakthrough in elderly non-Hodgkin lymphomas patients treated with Rituximab based chemotherapy. In: Digestive and Liver Disease. 2016 ; Vol. 48, No. 11. pp. 1394-1397.
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abstract = "Background Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27{\%} of patients with “resolved” HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression. Viral breakthrough occurs with non-compliance to therapy and, also, when drug-resistant mutants emerge. The risk might be higher in fragile patients as elderlies. Aims Since no study addressed this question, we determined the rate of HBV-RS in patients >65 years undergoing Rituximab-containing chemotherapies for NHLs. Methods We evaluated 85 newly diagnosed NHL patients with resolved HBV infection, receiving Rituximab-containing chemotherapies. All received lamivudine. HBV DNA was checked at baseline, every 4 weeks, for 1 year after completion of Rituximab cointaining regimens. Results Nine patients (10{\%}) had HBV reactivation and HBV related hepatitis. All received entecavir and recovered without consequences. HBV reactivation was more likely to occur after an average of five R-CHOP cycles or during Fludarabine. Conclusions The rate of viral breakthrough (VBK), in our study population, is high considering that the patients were HBV DNA negative at baseline and suggest that Lamivudine prevention may not be sufficient in this population.",
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AU - Lambertenghi Deliliers, Giorgio

AU - Cicardi, Marco

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N2 - Background Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with “resolved” HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression. Viral breakthrough occurs with non-compliance to therapy and, also, when drug-resistant mutants emerge. The risk might be higher in fragile patients as elderlies. Aims Since no study addressed this question, we determined the rate of HBV-RS in patients >65 years undergoing Rituximab-containing chemotherapies for NHLs. Methods We evaluated 85 newly diagnosed NHL patients with resolved HBV infection, receiving Rituximab-containing chemotherapies. All received lamivudine. HBV DNA was checked at baseline, every 4 weeks, for 1 year after completion of Rituximab cointaining regimens. Results Nine patients (10%) had HBV reactivation and HBV related hepatitis. All received entecavir and recovered without consequences. HBV reactivation was more likely to occur after an average of five R-CHOP cycles or during Fludarabine. Conclusions The rate of viral breakthrough (VBK), in our study population, is high considering that the patients were HBV DNA negative at baseline and suggest that Lamivudine prevention may not be sufficient in this population.

AB - Background Rituximab-containing chemotherapies are offered to elderlies for treatment of non-Hodgkin lymphomas (NHL). From 0.7 to 27% of patients with “resolved” HBV infection develop HBV reactivation and related hepatitis during Rituximab-containing chemotherapies. Currently, several antiviral drugs are available for the prophylaxis of patients at risk for HBV reactivation, which include lamivudine, tenofovir, entecavir, and adefovir. Viral breakthrough may occur during therapy, which is defined as an abrupt increase in serum HBV DNA levels after a period of persistent suppression. Viral breakthrough occurs with non-compliance to therapy and, also, when drug-resistant mutants emerge. The risk might be higher in fragile patients as elderlies. Aims Since no study addressed this question, we determined the rate of HBV-RS in patients >65 years undergoing Rituximab-containing chemotherapies for NHLs. Methods We evaluated 85 newly diagnosed NHL patients with resolved HBV infection, receiving Rituximab-containing chemotherapies. All received lamivudine. HBV DNA was checked at baseline, every 4 weeks, for 1 year after completion of Rituximab cointaining regimens. Results Nine patients (10%) had HBV reactivation and HBV related hepatitis. All received entecavir and recovered without consequences. HBV reactivation was more likely to occur after an average of five R-CHOP cycles or during Fludarabine. Conclusions The rate of viral breakthrough (VBK), in our study population, is high considering that the patients were HBV DNA negative at baseline and suggest that Lamivudine prevention may not be sufficient in this population.

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