Lymphoma patients with resolved hepatitis B virus (HBV) infection receiving rituximab are at risk for HBV reactivation, which may lead to hepatitis flare, liver failure, and even death. Antiviral prophylaxis is a common approach to manage the risk of HBV reactivation, but close surveillance may serve as a safe, feasible, and cost-saving alternative. This study primarily aimed to evaluate a surveillance protocol in managing the risk of HBV reactivation in this patient population.
This was a prospective, single-arm study conducted between June 2016 and June 2020 at the National Cancer Centre, Singapore. Lymphoma patients with resolved HBV infection and scheduled to receive rituximab-based treatment were eligible. HBV DNA levels were closely monitored every 4-6 weeks during rituximab treatment, every 6-8 weeks in the first year post treatment, and every 3-4 months in the second year post treatment. The efficacy of the surveillance protocol was examined by evaluating the rates of reactivation-related events. Feasibility was evaluated based on patient adherence. An economic analysis using a cost minimization approach was conducted to compare the costs between the surveillance protocol and universal prophylaxis with entecavir 0.5 mg daily up to 1 year after cessation of rituximab.
A total of 66 patients provided analyzable data with a follow-up period of 966.6 months. No hepatitis flare or reactivation-related events were detected. The median adherence rate to the surveillance protocol was 90.5%. Cost savings of $946.40 per patient over the entire surveillance period was achieved if the surveillance protocol was adopted and was most affected by changes in prophylaxis duration and the cost of antiviral prophylaxis.
The surveillance protocol is an effective, feasible, and cost-saving strategy to manage HBV reactivation among lymphoma patients with resolved HBV infection receiving rituximab.