Merli Michele, Rattotti Sara, Gotti Manuel, Arcaini Luca
a Division of Hematology , University Hospital Ospedale di Circolo & Fondazione Macchi, University of Insubria , Varese , Italy.
b Department of Hematology-Oncology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy.
Expert Opin Pharmacother. 2017 Mar;18(4):363-376. doi: 10.1080/14656566.2017.1288718. Epub 2017 Feb 15.
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.
在淋巴瘤患者中，检测出乙型或丙型肝炎病毒（HBV和HCV）血清学阳性具有至关重要的治疗意义。在HBV感染患者中，活动性（HBsAg阳性）或已治愈（HBsAg阴性/抗-HBcAb阳性）感染的血清学特征与基于利妥昔单抗治疗期间病毒再激活的不同风险相关，需要采取适当的监测和抗病毒预防策略。在HCV相关的非霍奇金淋巴瘤（NHL）患者中，综合数据表明基于干扰素（IFN）的抗病毒治疗（AT）能够诱导淋巴瘤消退，且与病毒根除密切相关，而新型直接抗病毒药物（DAA）的初步数据非常有前景。涵盖领域：本综述总结了接受基于利妥昔单抗治疗的患者中HBV再激活风险的当前证据，以及使用拉米夫定、恩替卡韦或替诺福韦进行抗病毒预防的适当选择，以及HBsAg阴性/抗-HBcAb阳性患者的抢先治疗策略。此外，还回顾了基于IFN的AT的既往经验以及近期DAA在HCV相关惰性淋巴瘤或弥漫性大B细胞淋巴瘤（DLBCL）中的研究。专家意见：建议对HBsAg阳性患者进行恩替卡韦或替诺福韦预防，而对于HBsAg阴性/抗-HBc阳性患者，可能首选拉米夫定进行普遍预防。对于无症状的HCV相关惰性淋巴瘤患者，基于DAA的AT应作为一线选择，而对于DLBCL，建议在免疫化疗诱导完全缓解后进行治疗。
