The combination of anti‑HBc and anti‑HBs levels is a useful predictor of the development of chemotherapy‑induced reactivation in lymphoma patients with resolved HBV infection

Abstract

Fatal chemotherapy-induced hepatitis B virus reactivation (HBV-R) is a well-described serious complication observed in patients with lymphoma and resolved HBV infection. The aim of the present study was to determine the predictive factors of the development of chemotherapy-induced HBV-R. A total of 77 consecutive newly diagnosed patients with lymphoma and resolved HBV infection, who received chemotherapy from 2007 through 2015 were analysed retrospectively. Significant predictive factors associated with HBV-R were identified based on the data from these patients. Ten patients developed HBV-R during and following chemotherapy, and two of these 10 patients developed HBV-associated hepatitis flares. There was a significant negative correlation between anti-hepatitis B core (HBc) titres prior to chemotherapy and time to HBV-R (P=0.016, R=−0.732). Univariate and multivariate logistic regression analyses demonstrated that anti-HBc and anti-hepatitis B surface (HBs) titres at baseline were significant predictive factors for HBV-R. In addition, patients with high anti-HBc titres at baseline (above 10 S/CO) were significantly more likely to experience HBV-R than patients with low anti-HBc and high anti-HBs titres (above 28 mIU/ml), who did not experience complete reactivation (P<0.0001). Furthermore, patients with low anti-HBs titres were significantly more likely to experience HBV-R than those with high anti-HBs titres (P=0.031). All HBV-R episodes among the patients with high anti-HBc titres occurred within 3 months following the initiation of chemotherapy. The combination of anti-HBc and anti-HBs titres, as opposed to either titre alone, at baseline in patients with lymphoma may serve as a surrogate marker for the occurrence of HBV-R under the influence of chemotherapy.

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

“…The American Gastroenterology Association Institute guideline recommends against using anti‐HBs status to decide whether or not a patient should receive antiviral prophylaxis irrespective of other risk factors . Using a combination of anti‐HBc and anti‐HBs levels may possibly be a tool to predict which patients with lymphoma and resolved HBV infection are at risk of HBV reactivation …”

“…The small molecule Bruton's tyrosine kinase (BTK) inhibitors, for example, ibrutinib, have shown promising results in the treatment of lymphoma and chronic lymphocytic leukemia . These agents block B‐cell antigen receptor signaling, which prevents the growth of malignant B cells and induces apoptosis .…”

“…1 Using a combination of anti-HBc and anti-HBs levels may possibly be a tool to predict which patients with lymphoma and resolved HBV infection are at risk of HBV reactivation. 35 The current meta-analysis involves mostly patients receiving chemoimmunotherapy or anti-CD20 monoclonal antibodies. Many novel agents for the treatment of hematological malignancies have been developed in the past decade and have shown promising results.…”

“…The small molecule Bruton's tyrosine kinase (BTK) inhibitors, for example, ibrutinib, have shown promising results in the treatment of lymphoma and chronic lymphocytic leukemia. [35][36][37][38][39][40][41][42][43][44][45][46][47] We recommend that, when ibrutinib is being considered, patients should first be screened for HBV infection, and those with chronic or resolved HBV be given antiviral prophylaxis with entecavir or tenofovir. Most of the studies included in this analysis used lamivudine for antiviral prophylaxis.…”

Analysis of the immunity effects after enhanced hepatitis B vaccination on patients with lymphoma

“…At present, inoculation of hepatitis B vaccine is not only the most direct and effective way to prevent HBV infection [5] but also can effectively prevent the reactivation of HBV after chemotherapy by increasing the titer of HbsAb in patients with lymphoma before chemotherapy [6,7]. 2017 Italian consensus guidelines, 'Recommendations for screening, monitoring, prevention, prophylaxis and therapy of hepatitis B virus reactivation in patients with hematological malignancies and patients who underwent heamatologic stem cell transplantation,' strongly recommend that all patients with HBV-negative hematological disorders should be vaccinated against hepatitis B, 1-2 weeks before chemotherapy, and their HBsAb titers should be monitored regularly [8].…”