Monitoring of hepatitis b virus (HBV) DNA and risk of HBV reactivation in B-cell lymphoma: A prospective observational study

Shigeru Kusumoto, Yasuhito Tanaka, Ritsuro Suzuki, Takashi Watanabe, Masanobu Nakata, Hirotaka Takasaki, Noriyasu Fukushima, Takuya Fukushima, Yukiyoshi Moriuchi, Kuniaki Itoh, Kisato Nosaka, Ilseung Choi, Masashi Sawa, Rumiko Okamoto, Hideki Tsujimura, Toshiki Uchida, Sachiko Suzuki, Masataka Okamoto, Tsutomu Takahashi, Isamu SugiuraYasushi Onishi, Mika Kohri, Shinichiro Yoshida, Rika Sakai, Minoru Kojima, Hiroyuki Takahashi, Akihiro Tomita, Dai Maruyama, Yoshiko Atsuta, Eiji Tanaka, Takayo Suzuki, Tomohiro Kinoshita, Michinori Ogura, Masashi Mizokami, Ryuzo Ueda

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background. There is no standard management of reactivation of hepatitis B virus (HBV) infection in HBVresolved patients without hepatitis B surface antigen (HBsAg), but with antibodies against hepatitis B core antigen and/or antibodies against HBsAg (anti-HBs). Methods. We conducted a prospective observational study to evaluate the occurrence of HBV reactivation by serial monthly monitoring of HBV DNA and to establish preemptive therapy guided by this monitoring in B-cell non-Hodgkin lymphoma (B-NHL) treated with rituximab plus corticosteroid-containing chemotherapy (R-steroidchemo). The primary endpoint was the incidence of HBV reactivation defined as quantifiable HBV DNA levels of ?11 IU/mL. Results. With a median HBV DNA follow-up of 562 days, HBV reactivation was observed in 21 of the 269 analyzed patients. The incidence of HBV reactivation at 1.5 years was 8.3% (95% confidence interval, 5.5-12.4). No hepatitis due to HBV reactivation was observed in patients who received antiviral treatment when HBV DNA levels were between 11 and 432 IU/mL. An anti-HBs titer of <10 mIU/mL and detectable HBV DNA remaining below the level of quantification at baseline were independent risk factors for HBV reactivation (hazard ratio, 20.6 and 56.2, respectively; P < .001). Even in 6 patients with a rapid increase of HBV due to mutations, the monthly HBV DNA monitoring was effective at preventing HBV-related hepatitis. Conclusions. Monthly monitoring of HBV DNA is useful for preventing HBV reactivation-related hepatitis among B-NHL patients with resolved HBV infection following R-steroid-chemo (UMIN000001299).

Original languageEnglish
Pages (from-to)719-729
Number of pages11
JournalClinical Infectious Diseases
Volume61
Issue number5
DOIs
Publication statusPublished - 2015

Keywords

  • HBV DNA monitoring
  • HBV reactivation
  • Preemptive antiviral therapy
  • Resolved HBV infection
  • Rituximab

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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    Kusumoto, S., Tanaka, Y., Suzuki, R., Watanabe, T., Nakata, M., Takasaki, H., Fukushima, N., Fukushima, T., Moriuchi, Y., Itoh, K., Nosaka, K., Choi, I., Sawa, M., Okamoto, R., Tsujimura, H., Uchida, T., Suzuki, S., Okamoto, M., Takahashi, T., ... Ueda, R. (2015). Monitoring of hepatitis b virus (HBV) DNA and risk of HBV reactivation in B-cell lymphoma: A prospective observational study. Clinical Infectious Diseases, 61(5), 719-729. https://doi.org/10.1093/cid/civ344