Impact of the timing of hepatitis B virus (HBV) identification and anti-HBV therapy initiation on the risk of adverse liver outcomes in patients receiving cancer therapy.

Abstract

6503 Background: Patients with cancer and hepatitis B virus (HBV) infection receiving cancer therapy are at risk for HBV reactivation. We aimed to determine the impact of early vs. late HBV identification and early vs. late/no anti-HBV therapy on adverse liver outcomes of patients with cancer with chronic (HBsAg+/anti-HBc+) or past (HBsAg-/anti-HBc+) HBV infection. Methods: We retrospectively studied adult patients with solid or hematologic malignancies who received chemotherapy during 2004-2011. Adverse liver-related events included hepatitis flares, liver failure, and death. Time-to-event analysis was used to determine incidence, and multivariable hazard models to determine predictors of outcomes. Early was defined as at the initiation of cancer therapy and late as after therapy initiation. Results: There were 18,688 study patients (80.4% had solid tumors). Among patients with hematologic malignancies, 89.6% had HBV testing of which 90.4% was early. Among patients with solid tumors, 10.8% had HBV testing of which 46.4% was early. Prevalence of chronic HBV was 1.1% (52/4905) and past HBV was 7.1% (350/4905). Among patients with chronic HBV with hematologic or solid malignancy, those identified late had 2.95 times (1.45-6.01) higher risk of liver failure than those identified early. Among chronic HBV patients, 59% (23/39) with early testing had early initiation of anti-HBV therapy, while all of those tested late had late/no initiation of anti-HBV therapy. Predictors of liver failure were male sex, chronic HBV, and late HBV identification for patients with solid tumors, and allogeneic SCT for patients with hematologic malignancies. Conclusions: Early HBV identification correlated with early anti-HBV therapy initiation and reduced risk of liver failure after chemotherapy in chronic HBV patients with solid tumors or hematologic malignancies as well as patients with past HBV and solid tumors.