News in brief: Liver failure fatality highlights risk of Hep B reactivation with rituximab; Potential paradigm shift in LBCL with CAR T-cell therapy; Lifelong anaemia risk after bariatric surgery

Wednesday, 14 Jul 2021

Liver failure fatality highlights risk of Hep B reactivation with rituximab

The risk of hepatitis B reactivation must be considered in patients with haematological malignancy before prescribing B-cell-depleting therapies, according Australian clinicians who report a fatal case of liver failure in a patient treated with rituximab for B-cell lymphoma.

Doctors at Austin Health said the 93 year old man had tested positive for HBcAb and negative for HBsAg and HBsAb prior to chemotherapy, but had not received antiviral prophylaxis prior to receiving R-CHOP chemotherapy 10 months prior to the hepatitis B reactivation.

They said the case highlighted that hepatitis B reactivation could be delayed by many months after exposure to rituximab.

“Universal hepatitis B screening of patients receiving chemotherapy and prophylactic antiviral treatment with entecavir or tenofovir are endorsed by most gastroenterology and oncology society guidelines,” they noted in BMJ Case Reports.

Potential paradigm shift in LBCL with CAR T-cell therapy

The CAR T-cell therapy axicabtagene ciloleucel (Yescarata) has shown superiority over usual care in second-line relapsed or refractory large B-cell lymphoma (LBCL) but it’s early days.

An interim analysis of the open-label phase 3 ZUMA-7 trial of 359 patients across 77 centres met its primary endpoint of event-free survival (EFS; hazard ratio 0.398, p <0.0001) after a median of two years follow-up.

The trial also met its secondary endpoint of objective response rate (ORR), according to a press release issued by maker and Gilead company Kite.

“The top-line results of the randomized ZUMA-7 trial paint the picture of a potential paradigm shift in the treatment of large B-cell lymphoma,” Frederick L. Locke, MD, ZUMA-7 lead principal investigator and co-leader of the Immuno-Oncology Program at Moffitt Cancer Center in Tampa, Florida, said.

“The outcomes for patients relapsing after frontline chemotherapy in this study are dramatically improved with rapid referral (to a CAR T center) and a single infusion of axicabtagene ciloleucel as compared to chemotherapy and consolidative autologous transplant, the longstanding second-line standard of care.”

The company cautions that the data is still immature, detailed results will be submitted for presentation at a future medical congress.  Kite plans to initiate discussions with the FDA, EMA and other global health authorities to expand the currently approved indications for Yescarta.

Lifelong anaemia risk after bariatric surgery

The long term risk of anaemia seen in patients who undergo bariatric surgery shows that postoperative clinical reviews and screening for micronutrient deficiencies are needed for life, new research shows.

The first data from a prospective study of patients undergoing bariatric surgery with a follow-up period of up to 20 years showed that anaemia became increasingly prevalent over time.

The study found that among more than 2000 patients who had bariatric surgery, the incidence of anaemia was five time higher than a control group in the gastric bypass group, 2.7 times higher in the vertical-banded gastroplasty group and 2.8 times higher in the gastric banding group.

Despite an increase in iron deficiency anaemia over time, only about 20% of patients were taking iron supplements.

“Our study highlights the importance of patients’ lifelong compliance to nutritional supplements after bariatric surgery, and the need for regular monitoring to prevent and detect serious nutritional deficiencies early,” the study authors concluded.

The findings are published in Lancet Diabetes and Endocrinology.

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