The Efficacy Contrast Of Lamivudine And Enticavir In Preventing Rituximab-associated Hepatitis B Virus Reactivation In Patients With B-cell Non-hodgkin Lymphoma Complicated Hbv Infection During Chemotherapy

Objective:To investigate the efficacy of lamivudine and enticavir in preventing Rituximabassociated hepatitis B virus reactivation in patients with B-cell non-Hodgkin lymphoma complicated HBV infection during chemotherapy.Methods:This was a retrospective study including 216 B-cell non-Hodgkin lymphoma patients with complete data from January 2012 to January 2017 treated in 3 hospitals.Of 30 patients were HBV surface antigen positive,and 78 patients were with past/resolved Hepatitis B.30 patients with HBsAg(+)received formal chemotherapy were divided into Lamivudine prophylactic group(14)and Entecavir prophylactic group(16).78 patients with past/resolved Hepatitis B were divided into Lamivudine prophylactic group(17),Entecavir prophylactic group(11)and control group(50).Analyze the change of HBVM,HBV DNA and liver function before or after rituximab combination chemotherapy.The incidence of HBV reactivation,liver function injury and chemotherapy delay were compared in each group.Results:1.The differences of sex,age,liver function(ALT,AST,TBil,ALB),PTA,BMI and complications were not statistically significant before chemotherapy in HBsAg(+)group and past/resolved Hepatitis B group(P>0.05).The rate of HBV reactivation in patients with resolved Hepatitis B was significant lower than patients with HBsAg(+)(P=0.047).2.Among 30 HBsAg(+)patients,1 patient(6.25%)in ETV prophylactic group and 6patients(42.86%)in LAM prophylactic group developed HBV reactivation(P=0.031).3.Compared to the other 71 patients,7 cases experienced HBV reactivation in 78 patients with resolved Hepatitis B.There was no statistically significant differences between the two groups for patient demographics,pathological pattern,chemotherapyregimen.6 patients in the control group developed HBV reactivation(12%)and 1 patient in LAM prophylactic group(5.88%),none had HBV reactivation in ETV prophylactic group.4.A total 7 cases experienced HBV reactivation in 78 patients with resolved Hepatitis B,respectively 2 cases in the first chemotherapy period,2 cases in the third chemotherapy period,1 case in the fifth chemotherapy period,the last one occurred after the completion of chemotherapy.4 patients had HBsAg revese seroconversion,occurred in the 1,3,5 cycles during and after the completion of chemotherapy.20 patients(40%)experienced liver function parameters abnormal in the control group,4 cases(23.5%)in LAM prophylaxis group,2 cases(18.2%)in ETV prophylaxis group during chemotherapy.Conclusion :Among B-NHL patients treated with rituximab combination chemotherapy,the rate of HBV reactivation in patients with resolved Hepatitis B was significantly lower than in HBsAg(+)patients.Antiviral prophylaxic can potentially prevent rituximab associated HBV reactivation in both patients with HBsAg(+)and patients with resolved Hepatitis B.Entecavir can more reduce the risk of rituximab associated HBV reactivation than Lamivudine.