医学
胃肠病学
乙型肝炎表面抗原
内科学
乙型肝炎病毒
乙型肝炎
美罗华
强的松
化疗
淋巴瘤
切碎
肝炎
长春新碱
免疫学
环磷酰胺
病毒
作者
Do Young Kim,Yu Ri Kim,Cheolwon Suh,Dok Hyun Yoon,Deok‐Hwan Yang,Yong Park,Hyeon Seok Eom,Jeong-Ok Lee,Jae-Yong Kwak,Hye Jin Kang,Shin Young Hyun,Jae‐Cheol Jo,Myung Hee Chang,Kwai Han Yoo,Sung-Nam Lim,Ho‐Jin Shin,Won Seog Kim,Inho Kim,Min Kyung Kim,Hyo Jung Kim,Won-Sik Lee,Yeung‐Chul Mun,Jin Seok Kim
标识
DOI:10.14309/ajg.0000000000002185
摘要
This prospective study aimed to investigate the efficacy and safety of preemptive antiviral therapy with tenofovir disoproxil fumarate (TDF) for HBsAg-positive patients with newly diagnosed diffuse large B-cell lymphoma receiving rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy.We enrolled 73 patients from 20 institutions. The primary end point was the absolute risk of hepatitis B virus (HBV)-related hepatitis during preemptive TDF therapy and for 24 weeks after withdrawal from TDF. Hepatitis was defined as a more than 3-fold increase in serum alanine aminotransferase from baseline or an alanine aminotransferase level of ≥100 U/L. HBV-related hepatitis was defined as hepatitis with an increase in serum HBV-DNA to >10 times that of the pre-exacerbation baseline or an absolute increase of ≥20,000 IU/mL compared with the baseline.No patient developed HBV reactivation or HBV-related hepatitis during preemptive antiviral therapy (until 48 weeks after completion of R-CHOP chemotherapy) with TDF. All adverse events were grade 1 or 2. HBV reactivation was reported in 17 (23.3%) patients. All HBV reactivation was developed at a median of 90 days after withdrawal from TDF (range, 37-214 days). Six (8.2%) patients developed HBV-related hepatitis at a median of 88 days after withdrawal from TDF (range, 37-183 days).Preemptive TDF therapy in HBsAg-positive patients with diffuse large B-cell lymphoma receiving R-CHOP chemotherapy was safe and effective for preventing HBV-related hepatitis. However, a long-term maintenance strategy of preemptive TDF therapy should be recommended because of the relatively high rate of HBV-related hepatitis after withdrawal from TDF ( ClinicalTrials.gov ID: NCT02354846).
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