Rituximab maintenance therapy for follicular lymphoma.

摘要

In the randomised PRIMA trial (Jan 1, p 42), 2 years of rituximab maintenance therapy after immuno-chemotherapy as first-line treatment for follicular lymphoma significantly improved progression-free survival. One death from fulminant hepatitis B was reported in the rituximab maintenance group, which was probably caused by rituximab-associated reactivation of hepatitis B virus (HBV). This topic deserves further discussion. First, although only one HBV reactivation event was reported in this trial, we believe-caution should be drawn, since in a previous study a quarter of cases of HBV reactivation developed into fulminant hepatic failure and the mortality was 100%. Moreover, the PRIMA trial was done mainly in European countries, with a low prevalence of HBV infection. For east Asian countries-eg, China, Korea, and Japan-with very high HBV prevalence rates, the rate of HBV reactivation could be much higher after rituximab maintenance therapy. In a Hong Kong study of 21 lymphoma patients with previous resolved hepatitis B who were treated with rituximab, five developed HBV reactivation, including one patient who died of hepatic failure. In a Japanese study, HBV reactivation occurred during or after rituximab chemotherapy in six of 51 HBV carriers with lymphoma.