Monitoring of Hepatitis B Virus (HBV) DNA and Risk of HBV Reactivation in B-Cell Lymphoma: A Prospective Observational Study

作者：Kusumoto Shigeru; Tanaka Yasuhito; Suzuki Ritsuro; Watanabe Takashi; Nakata Masanobu; Takasaki Hirotaka; Fukushima Noriyasu; Fukushima Takuya; Moriuchi Yukiyoshi; Itoh Kuniaki; Nosaka Kisato; Choi Ilseung; Sawa Masashi; Okamoto Rumiko; Tsujimura Hideki; Uchida Toshiki; Suzuki Sachiko; Okamoto Masataka; Takahashi Tsutomu; Sugiura Isamu; Onishi Yasushi; Kohri Mika; Yoshida Shinichiro; Sakai Rika; Kojima Minoru; Takahashi Hiroyuki; Tomita Akihiro; Maruyama Dai

来源：Clinical Infectious Diseases, 2015, 61(5): 719-729.

DOI：10.1093/cid/civ344

• HBV DNA monitoring
• HBV reactivation
• resolved HBV infection
• rituximab
• preemptive antiviral therapy

Background. There is no standard management of reactivation of hepatitis B virus (HBV) infection in HBV-resolved 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-steroid-chemo). 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).

• 出版日期2015-9-1