Cancer Res Treat.  2008 Mar;40(1):36-38.

Hepatitis B Virus Reactivation in a Surface Antigen-negative and Antibody-positive Patient after Rituximab Plus CHOP Chemotherapy

• Kim EB
• Kim DS
• Park SJ
• Park Y
• Rho KH
• Kim SJ

Abstract

Rituximab is a monoclonal antibody that targets B-lymphocytes, and it is widely used to treat non-Hodgkin's lymphoma. However, its use has been implicated in HBV reactivation that's related with the immunosuppressive effects of rituximab. Although the majority of reactivations occur in hepatitis B carriers, a few cases of reactivation have been reported in HBsAg negative patients. However, reactivation in an HBsAg negative/ HBsAb positive patient after rituximab treatment has never been reported in Korea. We present here an HBsAg-negative/HBsAb-positive 66-year-old female who displayed reactivation following rituximab plus CHOP chemotherapy for diffuse large B-cell lymphoma. While she was negative for HBsAg at diagnosis, her viral status was changed at the time of relapse as follows: HBsAg positive, HBsAb negative, HBeAg positive, HBeAb negative and an HBV DNA level of 1165 pg/ml. Our observation suggests that we should monitor for HBV reactivation during rituximab treatment when prior HBV infection or occult infection is suspected, and even in the HBsAg negative/HBsAb positive cases.

Keyword

Rituximab; Hepatitis B virus; Lymphoma

MeSH Terms

Aged
Antibodies, Monoclonal, Murine-Derived
B-Lymphocytes
DNA
Female
Hepatitis
Hepatitis B
Hepatitis B e Antigens
Hepatitis B Surface Antigens
Hepatitis B virus
Humans
Korea
Lymphoma
Lymphoma, B-Cell
Lymphoma, Non-Hodgkin
Organothiophosphorus Compounds
Recurrence
Rituximab
Antibodies, Monoclonal, Murine-Derived
DNA
Hepatitis B Surface Antigens
Hepatitis B e Antigens
Organothiophosphorus Compounds

Figure

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  Fig. 1 The HBs antigen was negative before the rituximab-CHOP chemotherapy. At the time of relapse, a routine screening test revealed the presence of HBs antigen. The HBV DNA titer was increased to 1,165.9 pg/ml, while the liver function test showed normal values. After administering lamibudine, the HBV DNA titer decreased to 26.8 pg/ml. During the salvage chemotherapy, the liver function stayed within the normal range.

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