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Annals of Oncology Advance Access published online on June 26, 2009
Annals of Oncology, doi:10.1093/annonc/mdp230
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Retrospective and prospective studies of hepatitis B virus reactivation in malignant lymphoma with occult HBV carrier

N. Fukushima1,*, T. Mizuta2, M. Tanaka1, M. Yokoo1, M. Ide1, T. Hisatomi1, N. Kuwahara4, R. Tomimasu1, N. Tsuneyoshi1, N. Funai3 and E. Sueoka1

1 Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Saga University
2 Division of Hepatology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Saga University
3 Department of Hematology, Saga Prefectural Hospital Koseikan
4 Department of Blood Transfusion Medicine, Faculty of Medicine, Saga University, Saga, Japan

* Correspondence to: Dr N. Fukushima, Division of Hematology, Department of Internal of Medicine, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga 849-8501, Japan. Tel: +81-952-34-2366; Fax: +81-952-34-2017; E-mail: fukushin{at}cc.saga-u.ac.jp

Background: In surface antigen of hepatitis B virus (HBsAg)-positive carrier for anticancer treatment of malignant lymphoma, it is well recognized that reactivation of hepatitis B virus (HBV) occasionally occurs. However, there have been only a few studies of HBV reactivation in serum HBsAg-negative and hepatitis B core antigen (HBcAb)-positive occult HBV carriers. We looked at both retrospective and prospective studies to determine the prevalence, clinical course and risk factor of HBV reactivation during chemotherapy in lymphoma patients.

Patients and methods: Forty-eight of 127 (37.8%) lymphoma patients were HBsAg negative and HBcAb positive, and 24 of these patients were then given liver function tests and HBsAg tests monthly and serum HBV DNA every 3 months.

Results: HBV reactivation was observed in two patients (4.1%) who had received intensive chemotherapy including steroid and rituximab. Immediate administration of entecavir therapy after elevation of HBV DNA level was conducted, and this resulted in reduction of it and improvement of liver function test.

Conclusions: Rituximab plus steroid-containing regimens may increase the risk of HBV reactivation in HBsAg-negative and HBcAb-positive lymphoma patients. More ambitious prospective studies are required to establish clinically useful or cost-effective follow-up methods for control of HBV reactivation in lymphoma patients with occult HBV infection.

HBV reactivation, lymphoma, occult hepatitis B carrier

Received for publication September 8, 2008. Revision received March 4, 2009. Accepted for publication March 17, 2009.


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