Hepatitis B reactivation during treatment of tyrosine kinase inhibitors—Experience in 142 adult patients with chronic myeloid leukemia

Wang, Yu‐Hung; Liang, Ja-Der; Sheng, Wang‐Huei; Tien, Feng‐Ming; Chen, Chien-Yuan; Tien, Hwei‐Fang

doi:10.1016/j.leukres.2019.05.001

Cited by 18 publications

(28 citation statements)

References 18 publications

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“…TKIs are currently widely used as target therapy for lung cancers and chronic myeloid leukemia (CML). The HBVr risk was 26–38.5% among CML patients receiving imatinib from Taiwan and Korea studies [ 23 , 24 ]. A recent Taiwanese study observed a moderate HBVr risk of 9.4% among patients with non-small cell lung cancers receiving epidermal growth factor receptor inhibitor [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Lau

Wong

et al. 2021

Hepatol Int

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Background & Aim Hepatitis B reactivation related to the use of immunosuppressive therapy remains a major cause of liver-related morbidity and mortality in hepatitis B endemic Asia-Pacific region. This clinical practice guidelines aim to assist clinicians in all disciplines involved in the use of immunosuppressive therapy to effectively prevent and manage hepatitis B reactivation. Methods All publications related to hepatitis B reactivation with the use of immunosuppressive therapy since 1975 were reviewed. Advice from key opinion leaders in member countries/administrative regions of Asian-Pacific Association for the study of the liver was collected and synchronized. Immunosuppressive therapy was risk-stratified according to its reported rate of hepatitis B reactivation. Recommendations We recommend the necessity to screen all patients for hepatitis B prior to the initiation of immunosuppressive therapy and to administer pre-emptive nucleos(t)ide analogues to those patients with a substantial risk of hepatitis and acute-on-chronic liver failure due to hepatitis B reactivation.

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Section: Methodsmentioning

confidence: 99%

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Lau

Wong

et al. 2021

Hepatol Int

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“…30 None of the studies were randomized, and none had a control or comparison group except study by Wang et al (2019). 31 This poses Liver function (alanine transaminase levels), hepatitis B serology, and hepatitis B viral DNA levels are shown before and after receiving tyrosine kinase inhibitors. The total number of hepatitis B reactivation was calculated (whenever possible) and listed as well.…”

Section: Resultsmentioning

confidence: 99%

“…This also prevented us from confirming HBVr based on the definition stated previously. 30 None of the studies were randomized, and none had a control or comparison group except study by Wang et al (2019). 31 This poses a significant limitation to the level of evidence provided.…”

Section: Resultsmentioning

confidence: 99%

“…The reported incidence of Hepatitis B reactivation in patients who were HbsAg positive was 10.8 per 100 person-years in the retrospective cohort study where all but one patient did not receive primary prophylaxis. 31 The definition of Hepatitis B reactivation is variable in the literature. 4 Hepatitis B reactivation (HBVr) is usually defined by changes in alanine transaminase (ALT) levels, HBV serological markers, or HBV DNA.…”

Section: Discussionmentioning

confidence: 99%

“…20 There have been multiple reports of HBVr in patients receiving TKIs. [21][22][23][24][25][26][27][28][29][30][31][32] Due to their common use in hematology and oncology practice, there is increased interest in estimating the risk of chronic HBV reactivation associated with the tyrosine kinase inhibitors. There are several associated unanswered questions, including whether there is a need for screening all patients who will receive TKIs, how long patients with CML should be on HBV prophylaxis for and which are the best antiviral agents to use for prophylaxis of HBV patients on TKIs.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Hepatitis B Reactivation Among Patients With Chronic Myeloid Leukemia Treated With Tyrosine Kinase Inhibitors

et al. 2020

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Hepatitis B reactivation (HBVr) in cancer patients is a well-established complication due to chemotherapy-induced immunosuppression. Studies have reported HBVr associated with immunosuppressive medications, such as rituximab, methotrexate, and high dose steroids. There are different risks for different types of chemotherapy with rituximab carrying one of the highest risks for hepatitis B reactivation. Tyrosine kinase inhibitors (TKIs) are the standard of care in patients with chronic myeloid leukemia (CML). The risk of HBVr in chronic myeloid leukemia has been reported in many studies, but to this date, there are no clear guidelines or recommendations regarding screening and monitoring of HBV in CML patients receiving TKIs. We conducted this review to identify the risk of HBVr in patients with CML who are treated with tyrosine kinase inhibitors. We recommend testing for HBV status in patients who are to be treated with TKIs and to consider giving prophylaxis in those who are positive for HBsAg at baseline. More studies are needed to assess the risk of reactivation in patients with Hepatitis B core antibody positive receiving TKIs. Currently, monitoring such patients for reactivation may be the best strategy.

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Sex‐specific incidence of hepatitis B virus flares among Bcr‐Abl tyrosine kinase inhibitor users in Taiwan

Wang

Chu

Chang

et al. 2023

Pharmacoepidemiology and Drug

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BackgroundThe use of Bcr‐Abl TKI was found to be associated with hepatitis B (HBV) flares, with a more profound risk observed in females. This study was conducted to characterize the clinical features of patients with HBV flare among Bcr‐Abl TKI users, to estimate sex‐specific incidence rates of HBV flare, and to evaluate potential cumulative effect of Bcr‐Abl TKI.MethodsBcr‐Abl TKI users with chronic HBV infection were identified from Taiwan's National Health Insurance database. The HBV flare cases were identified within the cohort. Incidence rates of HBV flare between men and women were assessed. Nested case–control analysis was used to evaluate the cumulative effect of Bcr‐Abl TKI use on HBV flare.ResultsAmong 415 patients with chronic HBV infection treated with Bcr‐Abl TKI from 2005 through 2018, 45 flare cases (28 males and 17 females) were identified. Days between Bcr‐Abl TKI initiation and HBV flare was 319 days in women compared to 610 days in men. 66.7% of the flares occurred during TKI therapy. Twelve of the 45 patients died, half of them died around 6 months after hepatitis B flare. Incidence rates of HBV flare were 2.34 and 3.33 per 100 person‐years in males and females, respectively. Higher incidence was observed among patients with chronic myeloid leukemia. Cumulative effect of Bcr‐Abl TKI on HBV flare was not observed.ConclusionApproximately 10% of HBV carriers who used Bcr‐Abl TKI experienced HBV flare in Taiwan. The risk was higher in women and among patients with chronic myeloid leukemia.

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Hepatitis B reactivation during treatment of tyrosine kinase inhibitors—Experience in 142 adult patients with chronic myeloid leukemia

Cited by 18 publications

References 18 publications

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

APASL clinical practice guideline on hepatitis B reactivation related to the use of immunosuppressive therapy

Evaluation of Hepatitis B Reactivation Among Patients With Chronic Myeloid Leukemia Treated With Tyrosine Kinase Inhibitors

Sex‐specific incidence of hepatitis B virus flares among Bcr‐Abl tyrosine kinase inhibitor users in Taiwan

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