ArticleJHEP reports : innovation in hepatology2026
Severe hepatitis flares after antiviral withdrawal in chronic hepatitis B with lymphoma: Impact of rituximab.
Article in JHEP reports : innovation in hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND &
aimsRituximab-containing chemotherapy predisposes patients with chronic HBV (CHB) to severe HBV reactivation, but the clinical outcomes after prophylactic nucleos(t)ide analog (Nuc) withdrawal remain unclear. We evaluated the impact of rituximab on off-Nuc clinical course by comparing patients with lymphoma-CHB treated with or without rituximab and patients with HBeAg-negative CHB.
methodsWe compared off-Nuc outcomes among rituximab-treated lymphoma-CHB (n = 132), non-rituximab lymphoma (n = 26), and HBeAg-negative CHB controls (n = 939) using propensity score matching (PSM) and inverse probability treatment weighting (IPTW). Sensitivity analyses using the Fine and Gray competing risk model confirmed the robustness of predictors.
resultsThe 2-year severe flare incidence was significantly higher in patients treated with vs. without rituximab (after IPTW, 22% vs. 8%, p <0.01) or in HBeAg-negative CHB (after PSM, 32% vs. 7%, p <0.01). Notably, 88% of relapse events occurred within the first year after discontinuation. Patients treated with rituximab showed steeper HBV DNA rebound kinetics (57% vs. 25% with ΔHBV DNA ≥1 log
conclusionsPatients with lymphoma-CHB treated with rituximab showed steeper off-therapy HBV DNA rebound and a higher risk of severe hepatitis flares after prophylactic Nuc withdrawal compared with those without rituximab and patients with HBeAg-negative CHB. Thus, close monitoring during the first year after Nuc cessation should be considered for rituximab-treated lymphoma-CHB, when most relapses occur. IMPACT AND IMPLICATIONS: Patients treated with rituximab had higher risk of severe flare with a steeper off-therapy HBV rebound kinetics compared with patients with non-rituximab lymphoma or HBeAg-negative CHB. Most clinical relapses occurred within the first year after discontinuation of prophylactic Nuc. Use of lower genetic barrier Nucs (lamivudine or telbivudine), a pretherapy HBV DNA ≥ 4 log
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