Wei-Yuan Chang1, Yen-Cheng Chiu2, Fang-Wei Chiu3, Yao-Chun Hsu4, Tai-Chung Tseng5,6, Pin-Nan Cheng2, Sheng-Shun Yang3,7,8,9, Chun-Jen Liu5,6,10, Tung-Hung Su5,6, Hung-Chih Yang5,10,11, Chen-Hua Liu5,6, Pei-Jer Chen5,6,10, Ding-Shinn Chen5,6,12, Jia-Horng Kao5,6,13,10. 1. Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan. 2. Department of Gastroenterology and Hepatology, National Cheng Kung University Hospital, Tainan, Taiwan. 3. Division of Gastroenterology & Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. 4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan. 5. Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 6. Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan. 7. School of Medicine, Chung Shan Medical University, Taichung, Taiwan. 8. Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan. 9. PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan. 10. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. 11. Department of Microbiology, National Taiwan University College of Medicine Taipei, Taiwan. 12. Genomics Research Center, Academia Sinica, Taiwan. 13. Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: Prophylaxis with nucleos(t)ide analogue (NA) is recommended to prevent hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients receiving rituximab-based B-cell depletion therapy. However, little is known about the risk of clinical relapse after withdrawal of NA. METHODS: We retrospectively analyzed 77 noncirrhotic HBsAg carriers with hematological cancer who received rituximab-containing chemotherapy. All of them received either prophylactic entecavir or tenofovir therapy. The risk of clinical relapse and hepatic decompensation after cessation of NA was explored. RESULTS: Clinical relapse and hepatic decompensation developed in 25 (32.5 %) and 11 (14.3 %) of the patients, respectively, and 2 patients died of hepatic decompensation. Most of the hepatic events occurred within 1 year (20 of 25; 80.0%) after stopping NA. A higher pretreatment viral load (≥2000 vs <2000 IU/mL) was associated with increased risks of clinical relapse (hazard ratio, 3.47; 95% confidence interval, 1.56-7.73) and hepatic decompensation (9.91; 2.14-45.92). Of 51 patients with pretreatment viral load <2000 IU/mL, clinical relapse occurred in 10 (19.6 %) and hepatic decompensation in 2 (3.9%). CONCLUSIONS: Pretreatment HBV DNA ≥2000 IU/mL is associated with increased risk of liver-related disease after cessation of prophylactic NA therapy in patients who received rituximab-containing chemotherapy.
BACKGROUND: Prophylaxis with nucleos(t)ide analogue (NA) is recommended to prevent hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients receiving rituximab-based B-cell depletion therapy. However, little is known about the risk of clinical relapse after withdrawal of NA. METHODS: We retrospectively analyzed 77 noncirrhotic HBsAg carriers with hematological cancer who received rituximab-containing chemotherapy. All of them received either prophylactic entecavir or tenofovir therapy. The risk of clinical relapse and hepatic decompensation after cessation of NA was explored. RESULTS: Clinical relapse and hepatic decompensation developed in 25 (32.5 %) and 11 (14.3 %) of the patients, respectively, and 2 patients died of hepatic decompensation. Most of the hepatic events occurred within 1 year (20 of 25; 80.0%) after stopping NA. A higher pretreatment viral load (≥2000 vs <2000 IU/mL) was associated with increased risks of clinical relapse (hazard ratio, 3.47; 95% confidence interval, 1.56-7.73) and hepatic decompensation (9.91; 2.14-45.92). Of 51 patients with pretreatment viral load <2000 IU/mL, clinical relapse occurred in 10 (19.6 %) and hepatic decompensation in 2 (3.9%). CONCLUSIONS: Pretreatment HBV DNA ≥2000 IU/mL is associated with increased risk of liver-related disease after cessation of prophylactic NA therapy in patients who received rituximab-containing chemotherapy.
Authors: Casey Lee McAtee; Joseph Lubega; Kristen Underbrink; Kristen Curry; Pavlos Msaouel; Martha Barrow; Eyal Muscal; Timothy Lotze; Poyyapakkam Srivaths; Lisa R Forbes; Carl Allen; M Brooke Bernhardt Journal: JAMA Netw Open Date: 2021-02-01