Recommendations for screening, monitoring, prevention, prophylaxis and therapy of hepatitis B virus reactivation in patients with haematologic malignancies and patients who underwent haematologic stem cell transplantation—a position paper

Abstract

Haematologic patients should be screened for hepatitis B surface antigen (HBsAg) plus anti-hepatitis B core protein (HBc), and HBV DNA before chemotherapy. HBV DNA levels should be monitored monthly in all HBV-positive patients who do not receive prophylaxis. HBsAg-positive haematologic patients and those undergoing HSCT should receive third-generation antiviral therapy as prophylaxis. Anti-HBc-positive lymphoma patients and those receiving HSCT should receive antiviral prophylaxis. All HBV-negative haematologic patients should be vaccinated for HBV. The acquisition of data from well-designed studies is desirable in the near future.

A snapshot of virological presentation and outcome of immunosuppression‐driven HBV reactivation from real clinical practice: Evidence of a relevant risk of death and evolution from silent to chronic infection

“…Among them, we found that 43% experienced HBV reactivation after suspending prophylaxis. This is in line with clinical cases of HBV reactivation after prophylaxis withdrawal and suggests the need to reconsider proper duration of antiviral prophylaxis particularly in onco‐haematological settings undergoing profound immunosuppression …”

“…This is in line with clinical cases of HBV reactivation after prophylaxis withdrawal [10][11][12] and suggests the need to reconsider proper duration of antiviral prophylaxis particularly in onco-haematological settings undergoing profound immunosuppression. 13 We found that patients experiencing HBV reactivation after suspending antiviral prophylaxis were characterized by higher median Based on the overall findings, novel virological or immunological parameters, capable to detect also minimal HBV replication, may provide an added value in diagnosing HBV reactivation at an early stage. In this regard, a recent study has shown that positivity to HBV core-related antigen (HBcrAg) is a significant risk factor for HBV reactivation in anti-HBc-positive/HBsAg-negative patients.…”

Hepatology Clearance for Immunomodulation in Patients With Hepatitis B

“…All societal guidelines recommend HBV serologies with HBsAg, HBcAb, and hepatitis B surface antibody (HBsAb). Based on the serology results, an assessment of HBV DNA PCR is recommended, which can be used as a baseline for follow‐up . This strategy may miss the rare patient with occult HBV who has a low titer of HBV DNA with negative HBsAg and HBcAb serologies; therefore, in selected high‐risk patients, HBV DNA quantification should be included in the initial screening …”

Contemporary analysis of functional immune recovery to opportunistic and vaccine‐preventable infections after allogeneic haemopoietic stem cell transplantation

“…51 Polyomavirus and norovirus infections were defined as positive PCR from blood and disease as detection of virus by PCR or immunohistochemistry in bodily fluids or organ tissue together with symptoms and/or signs in the affected organ. 52,53 The guidelines of Sarmati et al 54 were used to identify cases of Hepatitis B infection. Acute and chronic GVHD were classified according to the Glucksberg and the National Institute of Health criteria, respectively.…”