Liver dysfunction in hcv infected patients with CD20-Positive B-Cell Lymphoma undergoing rituximab combination chemotherapy

Background: Reactivation of chronic hepatitis B virus (HBV) infection with the development of fulminant hepatitis induced by chemotherapy and Rituximab is well known. However, less is known about liver dysfunction in patients with hepatitis C virus (HCV) who are undergoing treatment with Rituximab combination chemotherapy. Thus, the authors conducted this study to determine whether Rituximab induce HCV reactivation associated with hepatic injury. Methods: Ninety-eight pts. with CD20-positive B cell NHL receiving Rituximab combination at our institute were studied. All pts. were tested for HCV antibody, serum HCV-RNA levels and liver function, during and after treatment. Results: Ten of 98 pts. were positive for both anti-HCV and HCV RNA . Genotypes were 2a in 2 pts, 2c in 2 pts. and 1b in 6 pts. During treatment, serum HCV RNA and aminotransferase levels increased in all studied pts. In six pts, with genotype 1b, the addition of Rituximab to chemotherapy did not affect the tolerance to treatment. One patient, with genotype 2c, developed fulminant hepatitis and died of liver-related causes. Hepatic toxicity required hospitalization in 2 pts with genotype 2a and 1 patient with genotype 2c. Conclusions: In HCV patients undergoing treatment with Rituximab combination chemotherapy Genotype 2a/c are at high risk of hepatitis reactivation, however, it is difficult to determine whether liver dysfunction is caused only by Rituximab addition to chemotherapy. Liver dysfunction during Rituximab containing chemotherapy needs additional investigation even if our results suggest that virus heterogeneity is important and could have important implications for clinical management.