Hepatitis B in patients with hematological diseases: An update

Area of Science:

• Hepatology
• Oncology
• Virology

Background:

• Hepatitis B virus reactivation (HBVr) poses a significant clinical challenge in patients undergoing immunosuppressive therapy, particularly for oncohematological conditions.
• The spectrum of HBVr clinical manifestations ranges from mild hepatitis to life-threatening liver failure, highlighting the need for proactive management.

Purpose of the Study:

• To critically review recent literature on HBV reactivation following immunosuppressive treatments for oncohematological tumors.
• To inform clinicians about the risks associated with different virological categories and immunosuppressive drug classes.

Main Methods:

• A comprehensive computerized literature search was conducted in MEDLINE.
• Inclusion criteria focused on English-written articles, excluding abstracts and non-notable case reports.

Main Results:

• HBVr risk varies significantly based on patient virological status (active, occult, or inactive HBV carriers) and the type of immunosuppressive drug used.
• Predicting adverse outcomes is possible in certain patient groups, emphasizing the importance of risk stratification.

Conclusions:

• Hepatitis B virus screening is recommended for all patients with hematological malignancies commencing immunosuppressive treatment.
• Tailored therapeutic or preventive strategies, including antiviral prophylaxis or preemptive approaches, should be implemented based on virological status, drug risk, and liver health, aligning with international guidelines.