Abstract
It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.
Highlights
A Brief Historical Perspective on Hepatitis B Reactivation among Patients withHematological Malignancies Treated with ChemotherapyThe event of hepatitis B virus (HBV) reactivation (HBVr) has long been known to occur among patients undergoing treatment for hematological malignancies (HM), with reports mostly coming from the literature regarding the management of lymphomas
Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs
Multiple factors predisposing to hepatitis B virus reactivation (HBVr) among patients with serological signs of either current or previous, resolved hepatitis B infection affected by HM and undergoing immunosuppressive treatments have been identified and will be presented
Summary
To collect the most relevant and updated information on HBVr, a computerized literature MEDLINE search was performed using several combinations of the following terms: HBsAg, reactivation, lymphoma, hematology, immunosoppressive therapy, anti-HBc, occult carrier, and selecting potentially relevant related articles. 2007 [34], and its subsequent 2017 update published online (Italian version only) [37] These guidelines provide a systematic approach to immunosuppressed patients with serological signs of current or previous infection with HBV. This information was clearly summarized and translated in pragmatic management indications. The results of the present search will be arranged to follow the ideal philosophy of this latter paper, critically presenting the recent literature data in order to provide practical management indications on HBVr to the clinicians involved in the care of this special subgroup of immunosuppressed patients, as specialty care providers such as hematologists and oncologists, and their consultants (infectious disease specialists, internists, gastroenterologists, and hepatologists)
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