Prophylaxis against hepatitis B reactivation among patients with lymphoma receiving rituximab.

Hepatitis B virus (HBV) reactivation occurs commonly in patients with non-Hodgkin lymphoma, receiving rituximab-based therapeutic regimen. Guidelines from different organizations are not all in agreement with regard to screening and antiviral prophylaxis, given the limited evidence. Antiviral prophylaxis has been recommended for all HBV surface antigen-positive patients. Evidence for benefit from prophylaxis has recently been recognized among HBV surface antigen-negative/HBV core antibody-positive patients. Incidence of HBV reactivation varies in different geographical locations and the decision to start antiviral prophylaxis should consider local incidence data. Given the increased rates of rituximab-associated HBV reactivation and potentially fatal outcome, it is prudent that all patients who receive rituximab should be screened for HBV markers.