Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies in the targeted therapy era

Abstract

Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung’s disease (HD), meconium ileus due to Cystic Fibrosis, etc. The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis, such as anorectal manometry or rectal suction biopsy. What if there was another etiology of perinatal constipation, that is far lesser known? Cow’s milk protein allergy (CMPA) is often diagnosed in infants within the first few weeks of life, however, there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero, therefore allowing symptoms to show as early as day one of life. The presentation is more atypical, with perinatal constipation rather than with bloody stools, diarrhea, and vomiting. The diagnosis and management would be avoidance of cow's milk protein within the diet, with results and symptom improvement in patients immediately. Therefore, we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients. This entails first ruling out CMPA with safe, noninvasive techniques with diet modification, and if unsuccessful, then moving forward with further diagnostic modalities.

Prevention of hepatitis B reactivation in patients with hematologic malignancies treated with novel systemic therapies: Who and Why?

“…On the other hand, for resolved HBV infection the risk of reactivation associated with these new drugs is still a matter of debate. The current review by Mak et al [ 1 ] , as well as the one by Mustafayev and Torres[ 2 ], agree on a moderate/high risk of HBV reactivation and therefore a need of antiviral prophylaxis for patients undergoing a B cell-depleting regimen, an allogenic stem cell transplantation or an anthracyclines based chemotherapy, but a certain degree of uncertainty remains for chimeric antigens receptor (CAR)-T cell therapies and ICIs.…”

“…We read with interest the article recently published by Mak et al [ 1 ] reviewing prevention and management of hepatitis B virus (HBV) reactivation in the setting of hematologic malignancies in the era of new targeted therapies. They well differentiated two entities as HBV reactivation: Exacerbation of hepatitis B surface antigen (HBsAg) positive chronic hepatitis B (CHB) or reactivation of past/resolved HBV infection (HBsAg negative and hepatitis B core antibody positive).…”

“…They subsequently analyzed the risk of reactivation and therefore the need for antiviral prophylaxis associated with monoclonal antibodies and the novel targeted therapies in the hematological setting for both CHB and past/resolved HBV infection. For HBsAg positive patients there is a consensus, as also described in the review of Mustafayev and Torres[ 2 ] that patients treated with drugs which have a moderate (1%-10%) to high risk (> 10%) of reactivation, such as B-cell depleting drugs, immune checkpoint inhibitors (ICIs) and targeted therapies, should be given an antiviral prophylaxis as soon as the treatment has started[ 1 ].…”

Risk of hepatitis B virus reactivation in oncological patients treated with tyrosine kinase inhibitors: A case report and literature analysis

“…We were intrigued by the study conducted by Mak et al [ 1 ], which aimed to provide an updated guidance for monitoring or initiating antiviral prophylaxis in patients at risk of developing hepatitis B virus reactivation (HBVr). When focusing on Bruton tyrosine kinase (BTK) inhibitors, successful in treating various lymphoid malignancies, the authors emphasized the current absence of guidelines for prophylaxis and management of HBVr.…”

Overview of the immunological mechanisms in hepatitis B virus reactivation: Implications for disease progression and management strategies

“…The leading cause of HBV reactivation is an imbalance between the host’s immune response and virus replication. This phenomenon is of particular concern in individuals undergoing immunosuppressive therapies, such as chemotherapy or transplantation, chronic inflammatory diseases, and those with compromised immune systems[ 9 , 10 ].…”