Revised: January 27, 2014
Accepted: March 17, 2014
Published online: May 6, 2014
Over the past decade, the administration of anti-CD20 monoclonal antibodies such as rituximab has demonstrated various degrees of effectiveness and has improved patients’ outcomes during the treatment of autoimmune hematological disorders and hematological malignancies. However, the depletion of B-cells, the distribution of T-cell populations, and the reconstruction of host immunity resulting from the use of anti-CD20 monoclonal antibodies potentially lead to severe viral infections, such as hepatitis B virus (HBV), hepatitis C virus (HCV), parvovirus B19, and herpes viruses, in patients who are undergoing immune therapy or immunochemotherapy. Of these infections, HBV- and HCV-related hepatitis are a great concern in endemic areas because of the high morbidity and mortality rates in untreated patients. As a result, prophylaxis against HBV infection is becoming a standard of care in these areas. Parvovirus B19, a widespread pathogen that causes red blood cell aplasia in immunocompromised hosts, also causes hepatitis in healthy individuals. Recently, its association with hepatitis was recognized in a patient treated with rituximab. In addition, adenovirus, varicella-zoster virus, hepatitis E virus, and rituximab itself have been linked to the occurrence of hepatitis during or after rituximab treatments. The epidemiologies and pathogeneses of these etiologies remain unknown. Because of the increasing use of anti-CD20 monoclonal antibodies for the treatment of hematological malignancies or autoimmune hematological disorders, it is imperative that physicians understand and balance the risks of hepatotropic virus-associated hepatitis against the benefits of using anti-CD20 monoclonal antibodies.
Core tip: Anti-CD20 monoclonal antibodies are widely used for the treatment of hematological malignancies and autoimmune disorders. These agents produce prolonged B-cell depletion and significant immune suppression. In this review, we summarized the clinical use of anti-CD20 monoclonal antibodies and the reports of acute or chronic hepatitis associated with the use of these agents. Most of these hepatitis cases had viral etiologies. We discuss the mechanisms of the hepatitis caused by these drugs. These infections not only interrupted the immunotherapy but are also associated with high mortality and morbidity. This review may prompt physicians to monitor patients’ liver function more closely and to provide adequate prophylaxis while using these agents.