Scoring system for risk stratification of viral reactivation during prophylactic antiviral treatment in Korean patients with hepatitis B undergoing anticancer chemotherapy: A multicenter study

Abstract

Prophylactic antiviral therapy is recommended for hepatitis B virus (HBV)-infected patients with malignancies who are undergoing systemic chemotherapy. In the current study, we aimed to develop a risk scoring system to guide the selection of prophylactic antiviral agents. In this retrospective analysis, we included consecutive chronic hepatitis B patients who received antiviral prophylaxis for chemotherapy of solid or hematologic malignancies at three large-volume hospitals in Korea. The primary endpoint was HBV reactivation. The inverse probability treatment weighting method was used to minimize selection bias in terms of antiviral assignments. A total of 419 patients were enrolled: 129 patients received lamivudine (LAM), 216 received telbivudine (LdT), and 74 received entecavir (ETV), respectively. Of these, 36 patients developed on-treatment HBV reactivation (LAM, 17; LdT, 18; ETV, 1). Multivariate analysis identified three independent predictors for reactivation: hepatitis B e-antigen positivity, HBV DNA level, and type of malignancy. Accordingly, a risk scoring system was developed wherein one point was assigned for each of the risk factors. HBV reactivation occurred more frequently in the high-risk group (score ≥ 2) than in the low-risk group (hazards ratio, 14.17; P < 0.001). ETV exhibited superior prophylactic efficacy over LdT or LAM in the high-risk group, whereas no significant difference was noted in the low-risk group. The prognostic scoring system was useful for risk stratification of chemotherapy-related HBV reactivation. High genetic barrier agents appear to be vital for high-risk patients, whereas cost-effectiveness may be more relevant for low-risk patients.

KASL clinical practice guidelines for management of chronic hepatitis B

“…In a retrospective comparative analysis of 419 CHB patients who received chemotherapy for solid cancers and lymphoma in Korea, HBeAg positivity, serum HBV DNA, and cancer types were identified as risk factors related to hepatitis B reactivation, and a risk stratification tool was developed based these factors. This study also confirmed that entecavir had a better preventive effect than lamivudine or telbivudine in the high-risk group [ 400 ]. However, since most prophylactic therapy studies were conducted on lymphoma patients, prospective studies evaluating various malignancies including solid cancers on appropriate antiviral agents and treatment duration for each cancer type and anticancer drug are needed.…”

Tenofovir versus Entecavir on Outcomes of Hepatitis B Virus-Related Hepatocellular Carcinoma After FOLFOX-Hepatic Arterial Infusion Chemotherapy

“…16,17,29,33,34 HBV reactivation is a common complication in patients who undergo antitumor treatment, which may lead to antitumor treatment delays or discontinuation. [35][36][37][38] Among CHB patients with solid tumors without receiving antiviral 2128 treatment, the risk of HBV reactivation due to antitumor therapy was 25%. 35 Antiviral treatment can significantly reduce the occurrence of HBV reactivation after the treatment of the malignancy.…”

Prophylaxis, diagnosis and therapy of infections in patients undergoing high-dose chemotherapy and autologous haematopoietic stem cell transplantation. 2020 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…These screening tests should be repeated at least 30 days before HDC/ASCT. Monitoring of HBV viral load is strongly recommended in HBsAg and/or anti-HBc antibody positive patients for 6 months after HDC/ASCT, as immunosuppression can lead to viral reactivation and disease [41][42][43][44][45]. If maintenance therapy using rituximab, lenalidomide or bortezomib is administered, monitoring should be continued for 6 months following cessation of the respective maintenance therapy.…”