Lamivudine prophylaxis prevents hepatitis B virus reactivation in anti-HBc positive patients under rituximab for non-Hodgkin lymphoma

Dig Liver Dis. 2019 Mar;51(3):419-424. doi: 10.1016/j.dld.2018.08.024. Epub 2018 Sep 7.


Backgound: A significant proportion of hepatitis B surface antigen (HBsAg) negative/anti-hepatitis B core antigen (anti-HBc) positive patients with non-Hodgkin lymphoma (NHL) undergoing rituximab-based chemotherapy (R-CT) may suffer hepatitis B virus (HBV) reactivation.

Aims: We wanted to assess efficacy and safety of lamivudine (LMV) prophylaxis to prevent this complication.

Methods: Eighty-five consecutive HBsAg negative/anti-HBc positive NHL patients (71 years, 100% serum HBV DNA undetectable, 74% anti-HBs positive) received LMV coadministered with R-CT and for 18 months after the end of R-CT. Serum ALT, HBsAg, anti-HBs and HBV DNA were assessed every 4 months during and after end of LMV.

Results: During 39 (2-108) months of study period, including 21 months of LMV and 27 additional months after LMV discontinuation, one patient (2%) had HBV reactivation, 31 months after stopping LMV and during administration of new immunosuppressive regimens, without LMV prophylaxis, owing to incomplete oncological response. A 50% decline of anti-HBs titers occurred in 22/63 (35%) patients, including 12 who became anti-HBs seronegative. Five (6%) patients had ALT increase during R-CT but none required R-CT discontinuation. Seventeen (20%) patients died, all for tumour progression.

Conclusion: LMV prophylaxis is safe and effective in preventing HBV reactivation in HBsAg negative/anti-HBc positive NHL patients receiving R-CT.

Keywords: Anti-CD20; Chemotherapy; HBV; Nucleoside analog.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • DNA, Viral / blood
  • Drug Therapy, Combination
  • Female
  • Hepatitis B / prevention & control*
  • Hepatitis B Core Antigens / blood
  • Hepatitis B Surface Antigens / blood
  • Hepatitis B virus / physiology*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Italy
  • Lamivudine / therapeutic use*
  • Lymphoma, Non-Hodgkin / drug therapy*
  • Lymphoma, Non-Hodgkin / virology
  • Male
  • Middle Aged
  • Rituximab / therapeutic use*
  • Treatment Outcome
  • Virus Activation / drug effects


  • DNA, Viral
  • Hepatitis B Core Antigens
  • Hepatitis B Surface Antigens
  • Immunosuppressive Agents
  • Lamivudine
  • Rituximab