The compliance of our practice of hepatitis B virus screening with the current guidelines in patients undergoing chemotherapy for hematological malignancies

Yıl 2021, , 1095 - 1098, 01.11.2021

Funda Pepedil Tanrikulu , Didar Yanardağ Açık , Bilal Aygun , Mehmet Bankir , Mikail Özdemir

https://doi.org/10.28982/josam.981625

Cited By: 1

Öz

Background/Aim: The reactivation of Hepatitis B virus (HBV) among cancer patients is a critical issue which is preventable by precise detection of risky cases prior to the administration of chemotherapy drugs. This study aimed to investigate whether the evaluated serological tests for HBV screening before chemotherapy in adults with newly diagnosed hematological malignancies follow the guidelines.
Methods: In this retrospective cohort study, all patients with hematological malignancies who visited our hematology clinic between January 01, 2018-January 01, 2020, were examined and adult patients referred to the outpatient clinic for combined chemotherapy were included. All clinical data and laboratory results were obtained from the electronic hospital information system. Serological tests performed for HBV screening and their results were noted. The compliance of our clinical practice with the current guidelines was analyzed assuming that there are three mandatory serological tests for screening, HBsAg, anti-HBs and anti-HBc, recommended in the guidelines.
Results: A total of 91 newly diagnosed cases were included for analysis. HBV screening completely lacked in 10% of the patients and it did not follow the current guidelines in 30%. The most neglected serological test was anti-HBc. Regarding different hematological malignancies, the results were best in lymphoma patients (76% compliance with guidelines) and worst in MM (only 40% compliance with guidelines). The serological test results of eighty-two cases were also examined and the seropositivity rates for HBsAg and anti-HBc were 2%, and 41%, respectively.
Conclusion: We observed that the risk of reactivation was not adequately evaluated by serological screenings for HBV in adult patients receiving chemotherapy for hematological malignancy. To protect patients from this mostly preventable complication, it is necessary to increase the awareness on the subject and encourage more compliance with the related guidelines.

Anahtar Kelimeler

Hepatitis B virus, Hematological malignancies, Reactivation

Kaynakça

• 1. Global Hepatitis Report 2017. Geneva: World Health Organization; 2017. Report No: CC BY-NC-SA 3.0 IGO.
• 2. Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study. Clin Microbiol Infect. 2015;21:1020-6. doi: 10.1016/j.cmi.2015.06.028.
• 3. Lubel JS, Angus PW. Hepatitis B reactivation in patients receiving cytotoxic chemotherapy: diagnosis and management. J Gastroenterol Hepatol. 2010;25:864-71. doi: 10.1111/j.1440-1746.2010.06243.x.
• 4. Pattullo V. Prevention of Hepatitis B reactivation in the setting of immunosuppression. Clin Mol Hepatol. 2016;22:219-37. doi: 10.3350/cmh.2016.0024.
• 5. Aygen B, Demir AM, Gümüş M, Karabay O, Kaymakoğlu S, Köksal AŞ, et al. Immunosuppressive therapy and the risk of hepatitis B reactivation: Consensus report. Turk J Gastroenterol . 2018;29:259-69. doi: 10.5152/tjg.2018.18263.
• 6. European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370-98. doi: 10.1016/j.jhep.2017.03.021.
• 7. Sarin SK, Kumar M, Lau GK, Abbas Z, Chan HL, Chen CJ, et al. Asian-Pacific clinical practice guidelines on the management of hepatitis B: a 2015 update. Hepatol Int. 2016;10:1-98. doi: 10.1007/s12072-015-9675-4.
• 8. Weinbaum CM, Williams I, Mast EE, Wang SA, Finelli L, Wasley A, et al. Centers for Disease Control and Prevention (CDC). Recommendations for identification and public health management of persons with chronic hepatitis B virus infection. MMWR Recomm Rep. 2008;57:1-20.
• 9. Hoofnagle JH. Reactivation of hepatitis B. Hepatology. 2009;49:156-65. doi: 10.1002/hep.22945.
• 10. Pattullo V. Hepatitis B reactivation in the setting of chemotherapy and immunosuppression -prevention is better than cure. World J Hepatol. 2015;7:954-67. doi: 10.4254/wjh.v7.i7.954.
• 11. Hsu C, Tsou HH, Lin SJ, Wang MC, Yao M, Hwang WL, et al. Taiwan Cooperative Oncology Group. Chemotherapy-induced hepatitis B reactivation in lymphoma patients with resolved HBV infection: a prospective study. Hepatology. 2014;59:2092-100. doi: 10.1002/hep.26718.
• 12. Gentile G, Andreoni M, Antonelli G, Sarmati L. 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. Clin Microbiol Infect. 2017;23:916-23. doi: 10.1016/j.cmi.2017.06.024.
• 13. Ataca Atilla P, Yalçıner M, Atilla E, İdilman R, Beksaç M. Hepatitis B Reactivation Rate and Fate Among Multiple Myeloma Patients Receiving Regimens Containing Lenalidomide and/or Bortezomib. Turk J Haematol. 2019;36:266-73. doi: 10.4274/tjh.galenos.2019.2019.0103.
• 14. Evens AM, Jovanovic BD, Su YC, Raisch DW, Ganger D, Belknap SM, et al. Rituximab-associated hepatitis B virus (HBV) reactivation in lymphoproliferative diseases: meta-analysis and examination of FDA safety reports. Ann Oncol. 2011;22:1170-80. doi: 10.1093/annonc/mdq583.
• 15. Tsutsumi Y, Yamamoto Y, Ito S, Ohigashi H, Shiratori S, Naruse H, et al. Hepatitis B virus reactivation with a rituximab-containing regimen. World J Hepatol. 2015;7:2344-51. doi: 10.4254/wjh.v7.i21.2344.
• 16. Drößler L, Lehmann C, Töpelt K, Nierhoff D, Vehreschild JJ, Rybniker J, et al. HBsAg-negative/anti-HBc-positive patients treated with rituximab: prophylaxis or monitoring to prevent hepatitis B reactivation? Infection. 2019;47:293-300. doi: 10.1007/s15010-019-01271-z.
• 17. Sarı NG, Yıldırım Aİ, Doğu H, Yörük G. Hematolojik Maligniteli Hastalarda Hepatit B Virüs Serolojileri, Antiviral Profilaksi ve Reaktivasyon Hepatit Oranlarının Değerlendirilmesi. Turkiye Klinikleri J Med Sci. 2020;40(1):74-8. doi: 10.5336/medsci.2019-71432.
• 18. Korkmaz P, Demirtürk N, Aydın G, Ceken S, Aygen B, Toka O, et al. Awareness of hepatitis B virus reactivation among physicians administering immunosuppressive treatment and related clinical practices. Klimik Derg. 2019;32:146-53. doi: 10.5152/kd.2019.33.
• 19. Kawsar HI, Shahnewaz J, Gopalakrishna KV, Spiro TP, Daw HA. Hepatitis B reactivation in cancer patients: role of prechemotherapy screening and antiviral prophylaxis. Clin Adv Hematol Oncol. 2012;10:370-8.
• 20. Marignani M, Marzano A, Begini P, Vitolo U, Luminari S, Levis A, et al. Perception of hepatitis B virus infection reactivation-related issues among specialists managing hematologic malignancies: result of an Italian survey. Leuk Lymphoma. 2014;55:2564-71. doi: 10.3109/10428194.2013.879712.
• 21. Yuen MF. Need to improve awareness and management of hepatitis B reactivation in patients receiving immunosuppressive therapy. Hepatol Int. 2016;10:102-5. doi: 10.1007/s12072-015-9694-1.