The evaluation of hepatitis-b infection seroconversion in patients who has rituksimab treatment in OUR hematology clinic between the years 2010-2014

Purpose: The anti-CD 20 monoclonal antibody Rituksimab is one of the most used agents for treatment of hematological malignancies. It is known that there is an increase in reactivation of hepatitis infection after using Rituksimab. In this study we aimed to evaluate the Hepatitis-B infection seroconversion in patients who has treated with different regimens containing Rituksimab in our Hematology Clinic with varios hematological diagnosis between the years 2010-2014 at least end of the one year follow up period after treatment. Material and Method: We evaluated Hepatitis-B infection seroconversion in patients who has Rituksimab treatment in Hematology Clinic between the years 2010-2014 in our study. We studied about patients genders, ages, diagnosis, main treatment protocol they received, how many cycles of Rituksimab treatment they take, pretreatment level of ALT/AST/HBsAg/anti-HBs/HBcAb/HBV-DNA and at least end of the one year follow up period after the treatment level of ALT/AST/HBsAg/anti-HBs/HBcAb/HBV-DNA, correlation between diagnosis with HBV seroconversion and correlation between main treatment protocol they received with HBV seroconversion. We excluded the patients who doesn't completed the at least one year follow up period, those who has treated with non-Rituksimab regimens because of exists of the pretreatment HBsAg(+) and those who has additional malignancies that may affect the result of the study adversly. We reached to data from hospital automation system and patients files retrospectively. Data was presented as number and percentage. Pearson chi-square tests was used for statistycal analysis. P <0.05 was considered statistically significant. Findings: We reached 157 patients as a result of study. 96 of these patients (61.1%) men and 61 (38.9%) were female. The average ages of patients was 59.75 (21-91). Patients with several diagnosis such as NHL, KLL, HCL, ITP, MCL, BL, MZL, WM, AA, OIHA were taken Rituksimab containing regimens between 1-16 cycyles. The rate of HBsAg test been examined before treatment was found 61.2%. 34.4% of the patients were anti-HBs(-), 25.5% of the patients were anti-HBs(+) before treatment. When patients pretreatment levels of ALT, HBsAg and HBV-DNA evaluated with the treatments they have received and at least end of the one year follow up period after the treatment levels of ALT, HBsAg and HBV-DNA; there were HBV infection reactivation in 13 patients (8.2%) after treatment. When these patients pretreatment tests were evaluated; even six of those laboratory findings provide the criteria of HBV reactivation before the treatment. Two of these six patients had HBV-DNA(+) before the treatment and had regression in HBV-DNA viral load when they took anti-viral treatment before and process of the treatment, four of those had HBsAg(+), HBcAb(+), HBV-DNA(-) identified and had Rituksimab treatment with anti-viral treatment and HBsAg(+) was still exist and measurable HBV-DNA level was not detected at least end of the one year follow up period after the treatment. In a patient while he had HBsAg(-) before the treatment, had identified HBV-DNA(+) at least end of the one year follow up period after the treatment. When we examined, we haven't observed significant statistically difference between the treatments of patients that have received and HBV infection reactivation at least one year follow up period after treatment (Pearson chi-square value:11.43, p:0.782). When we examined, we haven't observed significant statistically difference between the diagnosis of patients and HBV infection reactivation at least one year follow up period after treatment (Pearson chi-square value:19.98, p:0.334). Results: HBV reactivation is common in immunsupresive conditions and has increases in patients who uses anti-CD20 monoclonal antibody Rituksimab. Therefore guidelines refers that these patients should be well monitorized in terms of HBV infection pretreatment, diagnostic process and after treatment. It was concluded that patients with high risk factors should be monitored more frequently. The reached result was treatment should be started pretreatment, diagnostic process and after treatment is more appropriate to the patients with the high risk of reactivation. In this study, there is any significant increase between the received treatment regimens, diagnosis and HBV reactivation. Key Words: Rituksimab, HBV infection, Reactivation, Hepatitis