To the Editor:
We read with interest the clinical review article on anti-CD20 antibody therapy for B-cell lymphomas by Maloney1 although we think that the section on HBV need to be better clarified.
Specifically the expression “carriers of the virus [HBV]” should be clearly defined. According to recently published EASL guidelines2 HBsAg-positive patients should receive pre-emptive
administration of nucleotide analogues during immunosuppressive therapy and for 12 months after its cessation; HBsAg-negative/antiHBc-positive patients with detectable HBV DNA should receive the same treatment although low quality evidences are available. In anti HBc-positive patients with undetectable HBV viremia a close monitoring (LFTs and HBV DNA) is suggested and should this not be feasible pre-emptive treatment is advised by some experts3. Given the dramatic fulminant hepatitis that have been described with HBV
reactivation and the efficacy of the antiviral treatment we strongly think that these classification need to be carefully evaluated before starting biological response modifiers including rituximab.
1. Maloney DG. N Engl J Med 2012;366:2008-16.
2. European Association for the Study of the Liver. Journal of Hepatology 2012;57:167–185. 3. Evens AM, Jovanovic BD, Su YC, Raisch DW, Ganger D, Belknap SM, et al.
Rituximab-associated hepatitis B virus (HBV) reactivation in lymphoproliferative diseases: meta-analysis and examination of FDA safety reports. Ann Oncol 2011;22:1170–1180.
