Early is superior to deferred preemptive lamivudine therapy for hepatitis B patients undergoing chemotherapy

Lau, George; Yiu, Harry; Fong, Daniel Yee Tak; Cheng, Ho Ming; Au, Wing‐Yan; Lai, Lydia S.F; Cheung, Micheal M H; Zhang, Haiying; Lie, Akw; Ngan, Roger K.C.; Liang, Raymond

doi:10.1053/j.gastro.2003.09.026

Cited by 422 publications

(386 citation statements)

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“…Almost all these patients had intense marrow suppression with a drastic reduction of white cell count, and the rebound of the white cell with immune recovery correlates with the initiation of liver damages [56]. Severe hepatitis due to HBV reactivation has also been reported in HBV-infected patients treated with chemotherapy for other malignancies such as breast cancer [10][11][12], hepatocellular carcinoma [18,57,58], small-cell lung cancer [59], and nasopharyngeal cancer [60].…”

Section: Chemotherapy or Immunosuppressive Therapy Related To Hbv Reamentioning

confidence: 99%

“…Even in the setting of bone marrow transplantation (BMT), only half of the patients will suffer from hepatitis due to HBV reactivation. Moreover, for those who were treated with cyclic cytotoxic chemotherapy, HBV reactivation usually will not occur until the second or third course of therapy [6,56]. At present, it is not at all clear what is the viral and host determinant factors to explain who will suffer from HBV reactivation.…”

Section: Risk Factors Involved In Hbv Reactivationmentioning

confidence: 99%

“…One can administer lamivudine before or at the initiation of cytotoxic therapy and cover the entire period of immunosuppression with anti-HBV nucleoside analogues (early preemptive therapy). Alternatively, one can monitor closely for serological evidence of HBV reactivation and use anti-HBV nucleoside analogues only when there is evidence of HBV virological reactivation (deferred preemptive therapy) [56,86]. Although early preemptive therapy reduces the need to closely monitor the serum HBV DNA level, it runs the risk of overtreating at least half of the patients with nucleoside analogues who would not develop HBV reactivation.…”

Section: Preemptive Use Of Nucleoside Analoguesmentioning

confidence: 99%

“…This is mostly due to the lack of data on occurrence of hepatic flares after the withdrawal of preemptive antiviral therapy in these patients. As HBV reactivation after cytotoxic or immunosuppressive therapy is usually accompanied by an upsurge of white cell counts from the nadir, our center has adopted a protocol of only withdrawing lamivudine once the total white cell count has normalized and at least 3 months after completion of chemotherapy [56]. The concept of this protocol or approach is to cover the entire period when the host interaction with HBV has been disturbed as a result of the cytotoxic or immunosuppressive therapy.…”

Section: Preemptive Use Of Nucleoside Analoguesmentioning

confidence: 99%

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Hepatitis B reactivation after chemotherapy: two decades of clinical research

Lau

2008

Hepatol Int

102

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Hepatitis due to hepatitis B virus reactivation after cytotoxic or immunosuppressive therapy is a serious cause of liver-related morbidity and mortality. With the characterization of the underlying pathogenesis, much progress in the management of this important clinical problem has been made in the past 2 decades. By year 2008, it is mandatory to screen for hepatitis B surface antigen status before initiating intensive chemotherapy or immunosuppressive therapy. All those who are hepatitis B surface antigen positive should be started on preemptive nucleos(t)ide analogues. However, there remains important issues, such as the type and duration of nucleos(t)ide analogue therapy, which need to be understood. As not all hepatitis B surface antigen-positive patients will suffer from HBV reactivation, it is therefore useful to identify risk factors related to HBV reactivation so that patients will not be treated unnecessarily with nucleos(t)ide analogues. To date, a high baseline level of viral replication, as reflected by high serum HBV DNA level, positive serum hepatitis B e antigen, and a high intrahepatic covalently closed circular DNA level, is the most important predictor for HBV reactivation. Recently, there has been an increased awareness of reactivation of occult hepatitis B virus, especially in hepatitis B virus endemic area, such as the Asia-Pacific region. Careful epidemiological study will be needed to clarify the impact of occult hepatitis B infection in patients treated with cytotoxic or immunosuppressive therapy. How important is the problem?Over the past 20 years of clinical practice at Queen Mary Hospital, we have seen a lot of progress in the management of hepatitis due to HBV reactivation in hepatitis B surface antigen carriers [1][2][3][4][5]. In the past, we saw patients who died of fulminant hepatic failure after being administered a few courses of cytotoxic therapy to treat their life-threatening lymphoma [6][7][8][9] and breast cancer [10][11][12] if they were also hepatitis B surface antigen positive. At that time, the literature report of this important clinical issue was scanty. The first report in the field was published by Wand et al. [13] who studied the effects of antitumor chemotherapeutic agents on hepatitis antigen (HBAg) and antibody (HBAb) in 25 patients with myeloproliferative and in 60 patients with lymphoproliferative disorders. This elegant study was performed at the time when only antigen and antibody associated with viral hepatitis could be semiquantified [14]. In those patients who had HBAg at the time of initiation of chemotherapy, bone marrow suppression by chemotherapeutic agents was associated with a marked increase in HBAg titer, which was then followed by hepatocellular damage, as manifested by an elevation in serum transaminase enzymes [13]. Since then, this important observation was further confirmed in other studies [8,15,16], with the rate of HBV reactivation ranging from 19% to 48%. Among them, one-quarter to half would be complicated, with severe hepatitis...

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Section: Chemotherapy or Immunosuppressive Therapy Related To Hbv Reamentioning

confidence: 99%

Section: Risk Factors Involved In Hbv Reactivationmentioning

confidence: 99%

Section: Preemptive Use Of Nucleoside Analoguesmentioning

confidence: 99%

Section: Preemptive Use Of Nucleoside Analoguesmentioning

confidence: 99%

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Hepatitis B reactivation after chemotherapy: two decades of clinical research

Lau

2008

Hepatol Int

102

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“…[5][6][7][8] Reactivation of HBV infection in cancer patients receiving chemotherapy may cause interruption of chemotherapy and, in severe cases, lead to liver failure and death. [9][10][11] Additionally, the prognosis of cancer may be compromised by disruption in anticancer treatment during the course of hepatitis, with a delay in treatment cycles and premature termination of chemotherapy. 4 Administering oral anti-HBV agents before chemotherapy is an effective means of reducing HBV reactivation and preventing fatal complications in patients with chronic HBV infection.…”

mentioning

confidence: 99%

Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area

et al. 2015

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Reactivation of hepatitis B viral (HBV) infection in cancer patients undergoing chemotherapy may cause interruption of chemotherapy and lead to liver failure and death. In our institute, a computerized order entry-based alert system was introduced in September 2011 to remind healthcare providers of HBV testing when prescribing chemotherapy. Since August 2012, an order entry-based therapeutic control system has been applied to ensure HBV prophylaxis during chemotherapy. This retrospective cohort study included cancer patients receiving chemotherapy in the Kaohsiung Veterans General Hospital from November 2009 to June 2013. The prechemotherapy HBV screening rate, HBV prophylactic rate, and severe HBV acute exacerbation rate were compared between stages with different order systems. Newly diagnosed cancer patients (n 5 2512) were included. The HBV testing rate in the screening reminder stage was higher than that in the educational stage (93.5% versus 40.2%, P < 0.001), whereas the adequate HBV prophylactic rates in the two order entry-based stages were comparable (41.1% versus 39.2%). Patients in the order entry-based therapeutic control stage had a higher HBV screening rate (99.3% versus 40.2%, P < 0.001) and a higher HBV prophylactic rate (95.8% versus 39.2%, P < 0.001) than those in the educational stage. Additionally, the severe HBV acute exacerbation rate in the therapeutic control stage was lower than those in the educational and screening reminder stages (0% versus 1.2% and 1.2%, respectively; both P < 0.01). Conclusion: A computerized order entry-based therapeutic control system can provide excellent prechemotherapy HBV screening for cancer patients undergoing chemotherapy and can effectively prevent severe acute exacerbation of HBV infection in hospitals among HBV endemic areas. (HEPATOLOGY 2015;62:387-396) 4 The incidence of HBV reactivation in patients with lymphoma and resolved hepatitis B after rituximab-based therapy ranges from 1.5% to 23.8%. [5][6][7][8] Reactivation of HBV infection in cancer patients receiving chemotherapy may cause interruption of chemotherapy and, in severe cases, lead to liver failure and death. 9-11 Additionally, the prognosis of cancer may be compromised by disruption in anticancer treatment Abbreviations: ALT, alanine aminotransferase; anti-HBc, antibody to hepatitis B core antigen; CI, confidence interval; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HCC, hepatocellular carcinoma.From the

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