Screening, monitoring, prevention, prophylaxis and therapy for hepatitis B virus reactivation in patients with haematologic malignancies and patients who underwent haematologic stem cell transplantation: a systematic review

Gentile, Giuseppe; Andreoni, Massimo; Antonelli, Guido; Sarmati, Loredana

doi:10.1016/j.cmi.2017.06.024

Cited by 36 publications

(44 citation statements)

References 58 publications

(57 reference statements)

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“…This position paper was developed from one meeting held in Rome in July 2015 that involved a team of experts from the SIMIT, the SIE, the GITMO and the SIVIM. It is based on a systematic literature review [2]. The initial article underwent several rounds of review by authors.…”

Section: Methodsmentioning

confidence: 99%

“…The initial article underwent several rounds of review by authors. The results of our systematic review [2] were evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology (http://gdt.guideli nedevelopment.org/app/handbook/handbook.html) to provide a systematic method of grading both the strength of the recommendation (weak or strong) and the quality of evidence (very low, low, moderate and high). According to GRADE criteria, evidence from randomized controlled studies, initially considered of high quality, were rated down if there was risk of bias, inconsistency of results, indirectness of evidence, imprecision of results and publication bias.…”

Section: Methodsmentioning

confidence: 99%

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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

Sarmati

Andreoni

Antonelli

et al. 2017

Clinical Microbiology and Infection

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Sarmati

Andreoni

Antonelli

et al. 2017

Clinical Microbiology and Infection

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show abstract

“…A recent systematic review summarized evidence from 42 published studies (randomized trials: 7, prospective cohort studies: 9, retrospective studies: 24 and combined retrospective-prospective studies: 2) on managing HBV in the setting of hematological malignancy and HSCT. 62 In patients with lymphoma not receiving prophylaxis, HBV reactivation varies from 24% to 85% in HBsAg-positive patients and 4% to 42% in patients with resolved HBV infection. The risk seems to be higher with the use of Rituximab (and any other anti-CD20 antibody).…”

Section: Hematological Malignanciesmentioning

confidence: 99%

“…Limited data suggests lower reactivation rates in patients with non-lymphoma hematological malignancy (5-28% in HBsAg-positive and 2-20% in resolved HBV infection). 62…”

Section: Hematological Malignanciesmentioning

confidence: 99%

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids

Arora

Anand

Kumar

et al. 2018

Journal of Clinical and Experimental Hepatology

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Hepatitis B Virus (HBV) reactivation in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids is emerging to be an important cause of morbidity and mortality in patients with current or prior exposure to HBV infection. These patients suffer a dual onslaught of illness: one from the primary disease for which they are receiving the culprit drug that led to HBV reactivation, and the other from HBV reactivation itself. The HBV reactivation not only leads to a compromised liver function, which may culminate into hepatic failure; it also adversely impacts the treatment outcome of the primary illness. Hence, identification of patients at risk of reactivation before starting these drugs, and starting treatment aimed at prevention of HBV reactivation is the best strategy of managing these patients. There are no Indian guidelines on management of HBV infection in patients receiving chemotherapy, biologicals, immunosupressants, or corticosteroids for the treatment of rheumatologic conditions, malignancies, inflammatory bowel disease, dermatologic conditions, or solid-organ or bone marrow transplantation. The Indian National Association for Study of the Liver (INASL) had set up a taskforce on HBV in 2016, with a mandate to develop consensus guidelines for management of various aspects of HBV infection, relevant to India. In 2017 the taskforce had published

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“…The HBV reactivation rate has been reported to be 24.4%-85% in patients with HBsAg-positive lymphoma and 4.1%-41.5% in lymphoma patients with resolved HBV infection [HBsAg negative/hepatitis B core antigen (anti-HBc) positive] (10, 11). In recent years, with the use of treatments containing rituximab in B-cell lymphoma patients with HsAg positivity and resolved HBV infection, a serious increase in the rate of HBV reactivation has been observed (12).…”

Section: Introductionmentioning

confidence: 99%

Hepatitis B Virus Reactivation in Patients with Previously Resolved Hepatitis B Treated with Rituximab-Containing Chemotherapy for B-Cell Lymphoma

Çakmak¹

2018

Erciyes Med J

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Objective: This study aimed to determine the frequency of HBV reactivation and the potential predictive factors in resolved hepatitis B virus (HBV) patients [hepatitis B surface antigen (HBsAg)-negative and antibody to hepatitis B core antigen (anti-HBc)-positive patients] who received rituximab-containing chemotherapy for B-cell lymphoma. Materials and Methods:A retrospective examination was performed for HBV-related markers in 106 patients before and after receiving rituximab-containing chemotherapy for CD20-positive B-cell lymphoma.Results: Of the 106 patients with CD20-positive B-cell lymphoma who received rituximab-containing chemotherapy, 98 were HBsAg negative and 8 were HBsAg positive; among the 98 patients, 64 (65.7%) were anti-HBc negative and 34 (34.7%) were anti-HBc positive. Of the 34 CD20-positive B-cell lymphoma patients with resolved HBV infection who received rituximab-containing chemotherapy, 26 (76.5%) were anti-HBsAg antibody (anti-HBs) positive and 8 (23.5%) were anti-HBs negative. Of these 8 anti-HBs-negative patients, HBV reactivation occurred in 4 (50%) patients; no HBV reactivation was observed in any of the 26 anti-HBs-positive patients. Compared with the anti-HBs-positive patients, the rate of HBV reactivation in B-cell lymphoma patients who were anti-HBs negative and had resolved HBV infection revealed a highly significant relationship (p<0.001).Conclusion: HBV reactivation occurred in 50% of the CD20-positive B-cell lymphoma anti-HBs-negative patients with resolved HBV infection who had received rituximab-containing chemotherapy and in none of the anti-HBs-positive patients. This indicates that anti-HBs negativity in the patients with resolved HBV infection is an important risk factor, and the antiviral prophylaxis should certainly be administered to such patients.

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Screening, monitoring, prevention, prophylaxis and therapy for hepatitis B virus reactivation in patients with haematologic malignancies and patients who underwent haematologic stem cell transplantation: a systematic review

Abstract: A higher quality of evidence is needed. However, the level of evidence was sufficient to support the recommendations published in this issue of the journal.

Cited by 36 publications

References 58 publications

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

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

INASL Guidelines on Management of Hepatitis B Virus Infection in Patients receiving Chemotherapy, Biologicals, Immunosupressants, or Corticosteroids

Hepatitis B Virus Reactivation in Patients with Previously Resolved Hepatitis B Treated with Rituximab-Containing Chemotherapy for B-Cell Lymphoma

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