Hepatitis B reactivation can occur during chemotherapy, and the risk is highest with anti-CD20 antibodies such as rituximab, high-dose steroids and stem cell transplantation. Reactivation can cause fulminant hepatitis and interrupt cancer treatment.
Test HBsAg and anti-HBc before starting. HBsAg-positive patients generally need antiviral prophylaxis; those who are anti-HBc positive and HBsAg negative need prophylaxis or close monitoring depending on the regimen. Prophylaxis typically continues for months after the last dose.
- Test HBsAg and anti-HBc before chemotherapy, especially with anti-CD20 antibodies.
- Start antiviral prophylaxis before treatment in HBsAg-positive patients.
- Plan prophylaxis or monitoring for anti-HBc-positive patients according to regimen risk.
- Continue prophylaxis for the recommended period after the last dose, not only during treatment.
Why it matters
Hepatitis B reactivation is preventable, and in India the carrier rate makes it a routine risk.
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