Risk of Hepatitis B Reactivation Among ALL Patients With Occult Hepatitis B Infection.

Area of Science:

• Hepatology
• Oncology
• Infectious Diseases

Background:

• Anticancer therapies, especially rituximab and stem-cell transplantation, elevate hepatitis B virus (HBV) reactivation risk in patients with occult hepatitis B infection (OHBI).
• The precise risk of HBV reactivation in acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL) patients undergoing intensive myelosuppressive chemotherapy remains unclear, impacting the established role of antiviral prophylaxis.

Purpose of the Study:

• To determine the risk of HBV reactivation in patients with ALL/LBL and OHBI receiving prolonged, intensive myelosuppressive chemotherapy.
• To evaluate the clinical significance of HBV reactivation in this patient population.

Main Methods:

• A prospective observational study was conducted at an Indian tertiary cancer center from October 2017 to August 2021.
• Patients aged 15 years and older with ALL/LBL were screened for OHBI, and liver function tests and HBV DNA levels were monitored throughout treatment and follow-up.
• The primary endpoint was the incidence of HBV reactivation.

Main Results:

• Occult hepatitis B infection (OHBI) was detected in 30.4% of patients.
• In the prospective cohort of 65 ALL/LBL patients with OHBI, HBV reactivation occurred in 9.2% (6/65), with no cases of HBV-related hepatitis.
• Seventeen patients experienced grade ≥3 hepatitis, leading to chemotherapy delays in five patients.

Conclusions:

• ALL/LBL patients with OHBI treated with pediatric-inspired protocols exhibit a moderate to high risk of HBV reactivation.
• Prophylactic antiviral therapy should be considered standard practice for these patients in HBV-endemic regions.
• The findings support the need for clear guidelines on antiviral prophylaxis in ALL/LBL patients with OHBI.