1Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan.
BACKGROUND & AIMS:
To elucidate the clinical characteristics of hepatitis B virus reactivation (HBV-R), we performed a prospective long-term study of patients with hematologic malignancy, including both HBV carriers and those with resolved HBV infection.
PATIENTS AND METHODS:
21 patients with hematopoietic stem-cell transplants (HSCT) and 36 patients given rituximab-based chemotherapy were enrolled. Entecavir was administered prophylactically to 8 patients with HBV surface antigen (HBsAg). HBV DNA was measured every month in 49 patients with resolved HBV infection, and preemptive therapy was given to 8 patients with HBV-R.
HBV-R developed in 5 (26%) of 19 patients with HSCT and 3 (10%) of 30 patients given rituximab-based chemotherapy. HBV-R occurred a median of 3 months (range: 2-10) after the end of rituximab-based chemotherapy and 22 months (range: 9-36) after HSCT. HBV-R did not develop in patients with an anti-HBs titer exceeding 200 mIU/ml at baseline. Mutations in the 'a' determinant region with amino acid replacement were detected in 4 of the 8 patients with HBV-R. Preemptive therapy prevented severe hepatitis related to HBV-R. Entecavir treatment was stopped in 4 patients with HBV-R. Since the withdrawal of entecavir, HBV DNA has not been detected in 2 patients persistently positive for antibodies against HBsAg (anti-HBs). No patient had fatal hepatitis.
Proper management of patients with HBsAg or resolved HBV infection prevented fatal hepatitis related to HBV-R in patients who received immunosuppressive or cytotoxic therapy. Entecavir could be safely discontinued in patients with HBV-R who had acquired anti-HBs.