Chapter 35 Diagnosis and Treatment of Diffuse Large B-Cell Lymphoma and Burkitt Lymphoma
Hepatitis B Prophylaxis and Therapy During Lymphoma Treatment
There is a risk of hepatitis B reactivation both from chemotherapy and rituximab, and this is a potentially fatal complication. We check hepatitis serology (hepatitis B surface antigen [HBsAg], hepatitis B surface antibody [anti-HBs], and hepatitis B core antibody [anti-HBc]) in all patients at diagnosis. Patients with active hepatitis B receive antiviral medication and LFTs, and hepatitis B viral loads are monitored closely. Patients with a history of hepatitis B infection should either receive antiviral prophylaxis or have the hepatitis B viral load monitored very closely (ideally on each cycle) with a low threshold to commence antiviral medications.
|All Patients||As Clinically Indicated|
|History and physical examination||Other viral studies|
|CBC and chemistry (including LDH)||CT or MRI of the head|
|HIV and hepatitis B and C serology||Body PET scan|
|Chest radiograph||Additional imaging|
|CT scan of the chest, abdomen, and pelvis||CSF evaluation by cytology or flow cytometry|
|BM aspirate and biopsy||Other tests indicated by results of staging|
BM, Bone marrow; CBC, complete blood count; CSF, cerebrospinal fluid; CT, computed tomography; LDH, lactate dehydrogenase; MRI, magnetic resonance imaging; PET, positron emission tomography.