Breakthrough HBV Infection in Children with Acute Lymphocyte Leukemia During Chemotherapy: A Prospective Study

Abstract

Background: Acute lymphocyte leukemia (ALL) is the most common cancer in children, and chemotherapy is the most effective treatment in clinical practice. The risk of occult hepatitis B virus (HBV) reactivation in adults patients undergoing immunosuppressive therapy has become more and more prominent. However, there were no study about the happening of HBV infection in ALL patients. In this study, we tried to explore the occurrence of HBV infection in child patients with ALL during chemotherapy. Methods: Seven hundred and thirty one child patients were involved in this study, who were diagnosed with ALL and receiving chemotherapy between August 2012 to December 2017. Demographic characteristics, clinical profile and changes of HBV seromarker in subjects pre- and during-chemotherapy were collected. Findings: Breakthrough HBV infection was identified in four subjects between 397 to 560 days after chemotherapy. During chemotherapy, high proportions of anti-HBc and anti-HBe seroconversion were found in child patients with ALL. Significantly low anti-HBs titers was detected in the HBV breakthrough patients. Interpretation: Breakthrough HBV infections could occur in ALL children during immunosuppressive therapy. The reactivation of occult HBV infection and transmit by blood transfusion should be take more attention. For the ALL child patients, the better time point for HBV infection test are between one and two years after chemotherapy. Younger child patients with significantly lower titers of protective anti-HBs during chemotherapy might have higher risk of breakthrough HBV infection. Funding Statement: This study was supported by the National Natural Science Foundation of China (No.81371876), Health and Family Planning Commission of Chongqing [2013] 39-2013-1-025 and Chongqing Municipal Colleges and Universities Outstanding Talent Support Program and Outstanding Youth Foundation of Children's Hospital of Chongqing Medical University. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The study was approved by the Ethics Review Committee of Children’s Hospital of Chongqing Medical University.