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

PURPOSE: Anticancer therapy increases the risk of hepatitis B virus (HBV) reactivation in patients with occult hepatitis B infection (OHBI), particularly in those who receive rituximab or stem-cell transplantation. However, the exact risk of HBV reactivation in patients with ALL/lymphoblastic lymphoma (LBL) receiving prolonged, intensive myelosuppressive chemotherapy is not known and thus the role of antiviral prophylaxis is not clearly established.

PATIENTS AND

METHODS

This prospective observational study was conducted at a single tertiary cancer center in India (October 2017 to August 2021). Patients age 15 years and older with ALL/LBL were screened for OHBI and enrolled. Liver function tests and HBV DNA levels were monitored at baseline, during treatment, and throughout follow-up phase. During episodes of hepatitis, extended serology panel was performed. The primary end point was the incidence of HBV reactivation.

RESULTS

OHBI was identified in 30.4% (172/566) of patients treated at our center during the study period. In the prospective cohort, 65 patients with ALL/LBL and OHBI, treated on a pediatric-inspired protocol, were enrolled. HBV reactivation occurred in six patients (9.2%; 95% CI, 4.3 to 18.7), none of whom developed HBV-related hepatitis. Seventeen patients experienced at least one episode of grade ≥3 hepatitis, with a median AST of 401 U/L (range, 192-3,490) and ALT of 430 U/L (range, 255-1,950). Hepatitis led to chemotherapy delays in five patients, with a median delay of 15.5 days (range, 7-39).

CONCLUSION

Our findings indicate a moderate to high risk of HBV reactivation in ALL/LBL patients with OHBI treated with pediatric-inspired protocols, particularly during maintenance, supporting prophylactic antiviral therapy as standard practice in regions with high or intermediate HBV endemicity.