Reactivation of hepatitis B virus following rituximab-based regimens: a serious complication in both HBsAg-positive and HBsAg-negative patients

Ann Hematol. 2010 Mar;89(3):255-62. doi: 10.1007/s00277-009-0806-7. Epub 2009 Aug 21.


Hepatitis B virus (HBV) reactivation is a well-known complication of lymphoma treatment in the pre-rituximab era. This complication has not been as well studied, however, since monoclonal anti-CD20 antibody became the standard regimen for B cell lymphoma. In this retrospective study, 115 B cell lymphoma patients who received rituximab-containing therapy were analyzed. Of 15 hepatitis B surface antigen (HBsAg)-positive patients, five received lamivudine prophylaxis and did not develop HBV-related hepatitis during lymphoma treatment. Eight of ten HBV carriers without lamivudine prophylaxis experienced HBV-related hepatitis, including one fatal hepatic failure. Four (4.2%) of 95 HBsAg-negative patients developed de novo HBV-related hepatitis and two died of fulminant hepatitis. In conclusion, rituximab-based therapy may cause serious HBV-related complications and even death in both HBsAg-positive and HBsAg-negative patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal, Murine-Derived
  • Female
  • Hepatitis B / etiology
  • Hepatitis B / prevention & control
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B virus / drug effects*
  • Hepatitis B virus / physiology
  • Humans
  • Incidence
  • Lamivudine / therapeutic use
  • Lymphoma, B-Cell / complications*
  • Lymphoma, B-Cell / drug therapy
  • Male
  • Middle Aged
  • Premedication
  • Retrospective Studies
  • Rituximab
  • Virus Activation / drug effects*


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Hepatitis B Surface Antigens
  • Lamivudine
  • Rituximab