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Open Access Research article

Management of the HBV reactivation in isolated HBcAb positive patients affected with Non Hodgkin Lymphoma

Mario Masarone1, Amalia De Renzo2, Vincenzo La Mura3, Ferdinando Carlo Sasso4, Marco Romano5, Giuseppe Signoriello6, Valerio Rosato4, Fabiana Perna2, Fabrizio Pane2 and Marcello Persico1*

Author Affiliations

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

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BMC Gastroenterology 2014, 14:31  doi:10.1186/1471-230X-14-31

Published: 17 February 2014

Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.

Keywords:
Occult HBV infection; Non Hodgkin Lymphoma; HBV reactivation; Immunosuppression