Tenofovir vs lamivudine for the prevention of hepatitis B virus reactivation in advanced-stage DLBCL

The anti-CD20 monoclonal antibody rituximab, together with anthracycline, in hepatitis B surface antigen (HBsAg) healthy carriers affected by non-Hodgkin lymphoma (NHL) increases hepatitis B virus (HBV) reactivation risk. 1 Oral primary antiviral prophylaxis (PAVP) is a common strategy in this setting.[2][3][4] Lamivudine (LAM) has shown to be effective.5 HBsAg-seropositive patients undergoing R-CHOP-21 (IV cyclophosphamide [750 mg/m 2 ], doxorubicin [50 mg/m 2 ], vincristine [1-4 mg/m 2 , maximum dose 2 mg], and rituximab [375 mg/m 2 ] on day 1, and oral prednisolone [100 mg] on days 1-5, administered every 21 days for a total of 6 cycles) 6,7 for diffuse large B-cell NHL (DLBCL) 8 with an adverse International Prognostic Index (IPI) score 9 are at high risk for antiviral prophylaxis failure.[2][3][4][5] Tenofovir disoproxil fumarate (TDF) is a new-generation oral nucleotide analog with stronger antiviral activity and a higher genetic barrier to resistance than LAM.[2][3][4][5] We report a prospective series of HBsAg-seropositive patients receiving TDF prophylaxis against HBV reactivation concurrently with R-CHOP-21 chemotherapy as remission induction for advanced-stage DLBCL.6,7 We then compared TDF efficacy and safety rates in these patients with those of a historical cohort treated with LAM.