entecavir and Lymphoma--Non-Hodgkin

In patients with lymphoma the detection of positive hepatitis B or C viruses (HBV and HCV) serology involves crucial therapeutic consequences. In HBV-infected patients the serological profile of active (HBsAg-positive) or resolved (HBsAg-negative/anti-HBcAb-positive) infection is associated to differential risk of viral reactivation during rituximab-based therapy and require appropriate strategies of monitoring and of antiviral prophylaxis. In HCV-associated NHL patients consolidated data demonstrated that interferon (IFN)-based antiviral therapy (AT) is able to induce lymphoma regression strictly related to viral eradication, while preliminary data of the new direct-acting antivirals (DAAs) are very promising. Areas covered: This review summarizes current evidences about HBV reactivation risk in patients undergoing rituximab-based treatments and appropriate options of antiviral prophylaxis with lamivudine, entecavir or tenofovir, as well as pre-emptive strategy in HBsAg-negative/HBcAb-positive patients. Moreover previous experiences with IFN-based AT as well as recent studies with DAAs in HCV-associated indolent lymphomas or diffuse large B-cell lymphoma (DLBCL) are reviewed. Expert opinion: Entecavir or tenofovir prophylaxis is recommended for HBsAg-positive patients, while universal prophilaxis with lamivudine may be preferred in HBsAg-negative/anti-HBc-positive patients. In asymptomatic patients with HCV-associated indolent lymphoma DAA-based AT should be used as first-line option, while in DLBCL its deliver after immunochemotherapy-induced complete remission is suggested.

Topics: Antiviral Agents; Guanine; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Surface Antigens; Hepatitis C; Humans; Lamivudine; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Rituximab; Tenofovir; Virus Activation

Rituximab (RTX), a chimeric mouse anti-human CD20 monoclonal antibody, is indicated for the treatment of patients with non-Hodgkin's lymphoma, chronic lymphocytic leukemia, granulomatosis with polyangiitis and microscopic polyangiitis, and rheumatoid arthritis, but nowadays it is increasingly used for the treatment of many other immune-mediated disorders. Hepatitis B virus (HBV) reactivation in RTX-treated patients, eventually leading to fatal liver failure, has been reported more often among hepatitis B surface antigen (HBsAg)-positive patients (overt infection) than in HBsAg-negative, antibody to hepatitis B core antigen (anti-HBc) seropositive patients (resolved infection).. This paper reviews the safety of RTX in patients with overt or resolved HBV infection, providing recommendations for its safe use in such patients.. Prior to starting RTX treatment, all patients should be screened for HBV infection. While HBsAg-positive active carriers should receive long-term antiviral treatment with entecavir (ETV) or tenofovir, inactive carriers are candidates for universal prophylaxis with lamivudine, or ETV or tenofovir in selected cases, to prevent hepatitis reactivation. Conversely, for HBsAg-negative anti-HBc positive carriers, that is, those with resolved HBV infection, universal prophylaxis with lamivudine is recommended for those with onco-hematological diseases, whereas watchful monitoring of HBsAg/HBV DNA levels is advisable for all the other indications.

Topics: Adenine; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Arthritis, Rheumatoid; Autoimmune Diseases; Carrier State; Disease Management; DNA, Viral; Guanine; Hepatitis B; Hepatitis B Surface Antigens; Hepatitis B virus; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Non-Hodgkin; Lymphoproliferative Disorders; Organophosphonates; Rituximab; Tenofovir; Virus Activation

Entecavir and tenofovir disoproxil fumarate are potent and effective antiviral drugs that now represent recommended treatment options for chronic HBV infection. However, no or very limited clinical evidence is currently available on these drugs for the management of HBV reactivation in patients with haematological malignancies. Herein, we report a case of HBV reactivation in a patient with non-Hodgkin's lymphoma following a rituximab-based regimen, and who was successfully treated with a combination antiviral treatment including entecavir and tenofovir disoproxil fumarate.

Topics: Adenine; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Drug Combinations; Female; Guanine; Hepatitis B virus; Hepatitis B, Chronic; Humans; Lymphoma, Non-Hodgkin; Middle Aged; Organophosphonates; Rituximab; Tenofovir; Virus Activation

A 49-year-old-man, a healthy carrier of hepatitis B virus (HBV), received chemotherapy with a rituximab/cyclo- phosphamide/doxorubicin/vincristine/prednisolone (R-CHOP) regimen for non-Hodgkin's lymphoma. At the first course of chemotherapy, not only the liver function but the HBV DNA level was elevated. These symptoms were diagnosed as hepatic injury induced by HBV reactivation, and, therefore, entecavir (ETV) was started. As a result, although the treatment with ETV decreased the HBV DNA level, liver function values were remarkably elevated again (over 3 times the levels before beginning ETV). ETV was discontinued because of suspicion regarding the onset of hepatic injury it caused. After switching to lamivudine (LVD), the liver function quickly improved and no problems were observed with renewal of the R-CHOP regimen. In addition, the HBV DNA level decreased and 3 courses of R-CHOP were performed successfully. In our case, the hepatic injury was induced by ETV, although anti-HBV medicine was used for the treatment of HBV reactivation according to the guideline. Therefore, the medical staff must carefully and consistently observe patients with HBV infection after chemotherapy.

Topics: Antibiotics, Antineoplastic; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Antineoplastic Agents, Alkylating; Antineoplastic Agents, Hormonal; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Carrier State; Chemical and Drug Induced Liver Injury; Cyclophosphamide; Doxorubicin; Guanine; Hepatitis B; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Prednisolone; Rituximab; Vincristine; Virus Activation

Topics: Adult; Amlodipine; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Guanine; Headache; Hepatitis B; Humans; Labetalol; Lymphoma, Non-Hodgkin; Male; Paresthesia; Prednisone; Substance Abuse, Intravenous; Sural Nerve; Treatment Outcome; Vasculitis