High Risk of clinical relapse in HBV-infected patients after cessation of prophylactic antiviral therapy for rituximab-containing chemotherapy.

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 following withdrawal of NA. PATIENTS: and Methods: We retrospectively analyzed 77 non-cirrhotic, HBsAg carriers with haematological malignancies 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 %) patients and 11 (14.3 %) patients, respectively, and 2 patients died of hepatic decompensation. Most of the hepatic events occurred within 1 year (20/25; 80.0%) after stopping NA. A higher pretreatment viral load (≥2000 vs. <2000 IU/mL) was associated with increased risks of clinical relapse (HR: 3.47, 95% CI: 1.56-7.73) and hepatic decompensation (HR: 9.91, 95% CI: 2.14-45.92). Of 51 patients with pretreatment viral load <2000 IU/mL, 10 (19.6 %) experienced clinical relapse and 2 (3.9%) developed hepatic decompensation. CONCLUSIONS: Pretreatment HBV DNA ≥2000 IU/mL is associated with increased risk of liver-related morbidities after cessation of prophylactic NA therapy in patients who received rituximab-containing chemotherapy.