Han Ji Won, Yang Hyun, Lee Hae Lim, Bae Si Hyun, Choi Jong Young, Lee Jong-Wook, Kim Hee Je, Lee Seok, Cho Seok Goo, Min Chang Ki, Kim Dong Wook, Yoon Seung Kew
Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
Division of Hematology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
Hepatol Res. 2016 Jun;46(7):657-68. doi: 10.1111/hepr.12603. Epub 2015 Nov 5.
Current guidelines recommend all patients scheduled to receive chemotherapy should be screened for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B virus core antigen (anti-HBc) status. However, still, more research is needed to identify the risk factors for hepatitis B virus (HBV) reactivation. We retrospectively investigated the incidence, risk factors and outcome of HBV reactivation in HBsAg negative patients with hematological malignancies.
Seven hundred and thirty-eight HBsAg negative patients with hematological malignancies were included in the study. HBV reactivation was defined as reverse seroconversion of HBsAg (HBsAg reappearance). Risk factors, cumulative incidence and overall survival of HBV reactivation were analyzed.
Reactivation occurred in 23 of the 738 (3.1%) enrolled patients. As expected, the reactivation rate of the anti-HBc positive group was significantly higher than that of the anti-HBc negative group (5.4% vs 0.8%). Multivariate analysis indicated that loss of antibody to the hepatitis B surface antigen (anti-HBs) was an independent risk factor. Patients with acute lymphoblastic leukemia and multiple myeloma showed significantly higher reactivation rate than those with other diseases. The cumulative incidence of HBV reactivation after starting chemotherapy in the anti-HBc positive subgroup was 0.3% at 1 year, 1.7% at 2 years and 10.5% at 3 years.
Close monitoring of HBV markers, including anti-HBs, should be performed for longer than 24 months. Further study is needed to establish a strategy to prevent HBV reactivation after chemotherapy in HBsAg negative patients with hematological malignancies.
当前指南建议，所有计划接受化疗的患者均应筛查乙肝表面抗原（HBsAg）及乙肝核心抗体（抗-HBc）状态。然而，仍需更多研究来确定乙肝病毒（HBV）再激活的危险因素。我们回顾性调查了HBsAg阴性血液系统恶性肿瘤患者HBV再激活的发生率、危险因素及转归。
本研究纳入738例HBsAg阴性血液系统恶性肿瘤患者。HBV再激活定义为HBsAg血清学逆转（HBsAg再次出现）。分析HBV再激活的危险因素、累积发生率及总生存期。
738例入组患者中有23例（3.1%）发生再激活。正如预期，抗-HBc阳性组的再激活率显著高于抗-HBc阴性组（5.4%对0.8%）。多因素分析表明，乙肝表面抗体（抗-HBs）缺失是独立危险因素。急性淋巴细胞白血病和多发性骨髓瘤患者的再激活率显著高于其他疾病患者。抗-HBc阳性亚组化疗开始后HBV再激活的累积发生率在1年时为0.3%，2年时为1.7%，3年时为10.5%。
应密切监测包括抗-HBs在内的HBV标志物超过24个月。需要进一步研究以制定策略，预防HBsAg阴性血液系统恶性肿瘤患者化疗后HBV再激活。
