Prevention of hepatitis B virus reactivation in patients with hematological malignancies and resolved hepatitis B virus infection: a systematic review and meta‐analysis

Abstract

Objective Patients with resolved hepatitis B virus (HBV) infection are at risk of HBV reactivation during treatment for hematological malignancies. We conducted a systematic review and meta‐analysis of the data on the efficacy of antiviral prophylaxis for the prevention of HBV reactivation in this group of patients. Methods We conducted a systemic literature search of PubMed including MEDLINE and EMBASE databases to 31 January 2019 to identify studies published in English comparing antiviral prophylaxis with no prophylaxis for HBV reactivation in patients treated for hematological malignancies. The search terms used were (“occult hepatitis B” OR “resolved hepatitis B”) AND (“reactivation”) AND (“haematological malignancy” OR “hematological malignancy” OR “chemotherapy” OR “immunotherapy” OR “chemoimmunotherapy” OR “lymphoma” OR “leukemia” OR “transplant”). The primary outcome was the reactivation of HBV infection. Pooled estimates of relative risk (RR) were calculated. Results We identified 13 relevant studies including two randomized controlled trials (RCT), one post hoc analysis from RCT and 10 cohort studies. There was a trend towards a lower rate of HBV reactivation using antiviral prophylaxis, but the difference was not significant (RR 0.57, 95% confidence interval [CI] 0.23–1.40, P = 0.22). When limiting the analysis to the three prospective studies of patients receiving anti‐CD20 monoclonal antibodies, we found antiviral prophylaxis was associated with a significantly lower risk of HBV reactivation (RR 0.17, 95% CI 0.06–0.49, P = 0.001). Conclusion Antiviral prophylaxis reduced the risk of HBV reactivation in patients receiving anti‐CD20 monoclonal antibodies for hematological malignancies but not in a broader group of patients receiving anticancer therapy.

Hepatitis B virus and hepatitis C virus reactivation in cancer patients receiving novel anticancer therapies

“…Anti-CD20 monoclonal antibodies rituximab, ofatumumab, and obinutuzumab can cause deep immunosuppression and enhance the HBV reactivation risk in patients with chronic and past HBV infection [29]. In prospective studies of patients with lymphoma receiving anti-CD20 monoclonal antibodies, prophylactic antiviral therapy was associated with a significantly lower risk of HBV reactivation (relative risk 0.17, 95% CI 0.06-0.49, P=0.001) [30].…”

HBV Reactivation in Patients with Past Infection Affected by Non-Hodgkin Lymphoma and Treated with Anti-CD20 Antibody Based Immuno-Chemotherapy: A Multicenter Experience

“…A meta-analysis including one randomized trial and several observational studies showed a pooled risk estimation of 16.9% reactivation rate (with transaminase elevation and/or detectable HBV DNA) in patients treated with R undergoing the pre-emptive strategy, thus not receiving upfront NAT [13]. In another recent meta-analysis of three prospective studies of patients who received anti-CD20 monoclonal antibodies, the pooled estimated relative risk was 0.17, indicating a significantly lower risk of HBV reactivation in the antiviral prophylaxis group [20]. Finally, in a previous Italian study, only 1 of 85 patients with past HBV infection treated with R-CT and receiving prophylactic LAM showed a serum conversion of HBsAg [19].…”

Data Mining and System Pharmacology to Elucidate the Efficiency and Mechanism of Chinese Medicine in Treating Primary Liver Cancer

“…chronic hepatitis B or C virus (HBV or HCV), cirrhosis, are the major risk factors for PLC. In China, 80% to 90% of PLC is associated with chronic HBV or HCV infection [3,4].…”