A 62-year-old man with diffuse large B-cell lymphoma is scheduled to receive R-CHOP chemotherapy including rituximab. Which pre-treatment screening test is mandatory before giving rituximab?

• A HLA typing
• B Quantiferon TB assay
• C Baseline echocardiography
• D Hepatitis B surface antigen and anti-HB core antibody ✓

Explanation

Rituximab depletes CD20-positive B cells and is a well-established cause of hepatitis B virus reactivation, sometimes presenting as fulminant hepatic failure even decades after exposure. All patients must be screened for HBsAg and anti-HB core antibody before starting therapy, and positive patients receive prophylactic antiviral cover with entecavir or tenofovir. Echocardiography is required before anthracyclines and trastuzumab, not rituximab, and HLA typing is irrelevant because these agents are not cell-based products.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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