Preemptive nucleos(t)ide analog treatment (NAT) guided by hepatitis B virus (HBV) DNA monitoring appears to be effective in preventing HBV-related hepatitis in patients with B-cell non-Hodgkin lymphoma (NHL) undergoing immunochemotherapy containing obinutuzumab or rituximab, according to a study published in Blood.

Researchers assessed the risk of HVB reactivation in 326 patients with B-cell NHL and resolved HBV infection who had received obinutuzumab- or rituximab-containing immunochemotherapy in the phase 3 GOYA and GALLIUM studies. A total of 119 patients received NAT, with 94 receiving prophylactic NAT for a median of 482.5 days and the remainder receiving preemptive NAT.

The incidence of HBV reactivation was 8.2% overall, 10.8% in patients who did not receive prophylactic NAT, and 2.1% in patients who received prophylactic NAT. None of the patients receiving prophylactic NAT developed HBV-related hepatitis. Detectable HBV DNA at baseline was strongly associated with an increased risk of reactivation as well (adjusted hazard ratio, 18.22).

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The authors concluded that preemptive NAT was an effective treatment for patients with B-cell NHL despite the higher associated risk of HBV reactivation because it avoided unnecessary antiviral treatment and did not seem to increase the risk of hepatitis. However, they recommended prophylactic NAT as a potentially appropriate option for patients at high risk for reactivation and with antiHBs seronegativity or detectable HBV DNA.

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1. Kusumoto S, Arcaini L, Hong X, et al. Risk of HBV reactivation in patients with B-cell lymphomas receiving obinutuzumab or rituximab immunochemotherapy [published online October 19, 2018]. Blood. doi: 10.1182/blood-2018-04-848044