Management of the HBV reactivation in isolated HBcAb positive patients affected with Non Hodgkin Lymphoma
1 Internal Medicine and Hepatology Unit, University of Salerno, Via Allende, Baronissi (Salerno) CAP: 84081, Italy
2 Haematology Department, Federico II University of Naples, Naples, Italy
3 AM Migliavacca Center for Liver Disease, First Division of Gastroenterology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
4 Internal Medicine and Hepatology Department, Second University of Naples, Naples, Italy
5 Gastroenterology and Endoscopy Department, Second University of Naples, Naples, Italy
6 Department of Statistical Sciences, Second University of Naples, Naples, Italy
BMC Gastroenterology 2014, 14:31 doi:10.1186/1471-230X-14-31Published: 17 February 2014
Occult HBV infection (OBI) is defined by the persistence of HBV in the liver without serum HBsAg and HBVDNA. It represents a life-threatening event during immunosuppressive chemotherapies. An OBI occurs in approximately 18% of HBcAb + patients. International guidelines suggest surveillance for HBV markers in immunosuppressed patients. In Non-Hodgkin Lymphoma (NHL), the prevalence of OBI reactivation remains to be established.
In order to determine the prevalence of occult HBV reactivation in a large cohort of patients during chemotherapy for NHL, we analysed 498 NHL patients in a centre of Southern Italy. We evaluated HBV markers, NHL type, treatment type and occurrence of HBV reactivation.
Forty % of patients were treated with monoclonal antibodies and 60.3% without. Ninety-six patients were HBcAb+, HBsAg-. HBV reactivation occurred in ten subjects of this subgroup. All of them were successfully treated with Lamivudine. None of the patients experienced liver-related death. The prevalence of OBI reactivation was of 10.42% in HBcAb + HBsAb- patients. This event occurred in 50% of patients treated with mild immunosuppressive therapies. Each reactivation was treated with Lamivudine.
This report suggests that a strict surveillance is important and cost-effective in HBcAb + HBsAg- NHL patients treated with mild immunosuppressive therapies, in order to detect an occult HBV reactivation.