利妥昔单抗含化疗后停止预防性抗病毒治疗的慢性乙型肝炎病毒感染者临床复发风险高。
High Risk of Clinical Relapse in Patients With Chronic Hepatitis B Virus Infection After Cessation of Prophylactic Antiviral Therapy for Rituximab-Containing Chemotherapy.
机构信息
Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
Department of Gastroenterology and Hepatology, National Cheng Kung University Hospital, Tainan, Taiwan.
出版信息
J Infect Dis. 2020 Sep 14;222(8):1345-1352. doi: 10.1093/infdis/jiaa256.
BACKGROUND
Prophylaxis with nucleos(t)ide analogue (NA) is recommended to prevent hepatitis B virus (HBV) reactivation in hepatitis B surface antigen (HBsAg)-positive patients receiving rituximab-based B-cell depletion therapy. However, little is known about the risk of clinical relapse after withdrawal of NA.
METHODS
We retrospectively analyzed 77 noncirrhotic HBsAg carriers with hematological cancer who received rituximab-containing chemotherapy. All of them received either prophylactic entecavir or tenofovir therapy. The risk of clinical relapse and hepatic decompensation after cessation of NA was explored.
RESULTS
Clinical relapse and hepatic decompensation developed in 25 (32.5 %) and 11 (14.3 %) of the patients, respectively, and 2 patients died of hepatic decompensation. Most of the hepatic events occurred within 1 year (20 of 25; 80.0%) after stopping NA. A higher pretreatment viral load (≥2000 vs <2000 IU/mL) was associated with increased risks of clinical relapse (hazard ratio, 3.47; 95% confidence interval, 1.56-7.73) and hepatic decompensation (9.91; 2.14-45.92). Of 51 patients with pretreatment viral load <2000 IU/mL, clinical relapse occurred in 10 (19.6 %) and hepatic decompensation in 2 (3.9%).
CONCLUSIONS
Pretreatment HBV DNA ≥2000 IU/mL is associated with increased risk of liver-related disease after cessation of prophylactic NA therapy in patients who received rituximab-containing chemotherapy.
背景
核苷（酸）类似物（NA）预防可用于预防接受利妥昔单抗为基础的 B 细胞耗竭治疗的乙型肝炎表面抗原（HBsAg）阳性患者乙型肝炎病毒（HBV）再激活。然而，在停止 NA 后临床复发的风险知之甚少。
方法
我们回顾性分析了 77 例接受含利妥昔单抗化疗的非肝硬化 HBsAg 携带者的血液恶性肿瘤患者。所有患者均接受恩替卡韦或替诺福韦预防治疗。探讨了停止 NA 后临床复发和肝失代偿的风险。
结果
25 例（32.5%）和 11 例（14.3%）患者分别发生临床复发和肝失代偿，2 例患者死于肝失代偿。大多数肝事件发生在停止 NA 后 1 年内（25 例中的 20 例；80.0%）。治疗前病毒载量较高（≥2000 与 <2000 IU/mL）与临床复发（危险比，3.47；95%置信区间，1.56-7.73）和肝失代偿（9.91；2.14-45.92）风险增加相关。51 例治疗前病毒载量 <2000 IU/mL 的患者中，10 例（19.6%）发生临床复发，2 例（3.9%）发生肝失代偿。
结论
在接受含利妥昔单抗化疗的患者中，停止预防性 NA 治疗后，治疗前 HBV DNA ≥2000 IU/mL 与肝脏相关疾病风险增加相关。
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