Abstract
We appreciate the comments raised in the correspondence from Marignani et al regarding our recently published article. The cost-effectiveness profile is thought to be an important issue. However, the ultimate goal is to be able to safely administer rituximab combination chemotherapy to patients who are positive for the hepatitis B surface antibody (anti-HBs) and/or hepatitis B core antibody and to cure the lymphoma. Therefore, a study is necessary to determine whether an antiviral drug should be given to these patients as prophylaxis before starting rituximab combination chemotherapy or after HBV-DNA is detected. In our study, among the patients positive for anti-HBs and/or hepatitis B core antibody who were receiving rituximab combination chemotherapy, entecavir was started when HBV-DNA was detected ( 1.8 log copies), and rituximab combination chemotherapy was continued. The outcome of treatment for lymphoma in these patients was good. With respect to whether lamivudine or entecavir should be administered, with lamivudine (cost of ¥683/d in Japan), HBV-resistant mutants appear in 20% to 30% of patients within 1 year, and in 50% to 60% of patients in 5 years. Breakthrough by the mutant occurs in 20% to 30% of patients. Few HBV-resistant mutants manifest when entecavir (¥1,038/d) is administered. The antiviral effect of entecavir is strong. Therefore, when HBV-DNA was detected, administration of entecavir was begun, and it seemed necessary to continue rituximab combination chemotherapy after the course of entecavir was completed. Thus, rituximab combination chemotherapy could be continued after entecavir administration was begun and when the serum HBV-DNA became negative. Regarding expense, the cost of testing for anti-HBs in Japan is ¥950, and the cost of testing for HBV-DNA is ¥2,900. Compared with the cost of prophylaxis with lamivudine (¥19,465/mo), the cost of testing for HBV-DNA (¥ 950/mo) is low. A large-scale prospective study on HBV-DNA monitoring to make an early diagnosis of HBV reactivation is necessary.
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