National Center for Cancer Care and Research, Doha, Qatar.
Department of Pharmacy, National Center for Cancer Care and Research, Doha, Qatar.
Cancer Control. 2020 Jan-Dec;27(1):1073274820976594. doi: 10.1177/1073274820976594.
Hepatitis B reactivation (HBVr) in cancer patients is a well-established complication due to chemotherapy-induced immunosuppression. Studies have reported HBVr associated with immunosuppressive medications, such as rituximab, methotrexate, and high dose steroids. There are different risks for different types of chemotherapy with rituximab carrying one of the highest risks for hepatitis B reactivation. Tyrosine kinase inhibitors (TKIs) are the standard of care in patients with chronic myeloid leukemia (CML). The risk of HBVr in chronic myeloid leukemia has been reported in many studies, but to this date, there are no clear guidelines or recommendations regarding screening and monitoring of HBV in CML patients receiving TKIs. We conducted this review to identify the risk of HBVr in patients with CML who are treated with tyrosine kinase inhibitors. We recommend testing for HBV status in patients who are to be treated with TKIs and to consider giving prophylaxis in those who are positive for HBsAg at baseline. More studies are needed to assess the risk of reactivation in patients with Hepatitis B core antibody positive receiving TKIs. Currently, monitoring such patients for reactivation may be the best strategy.
乙型肝炎病毒再激活（HBVr）是癌症患者由于化疗引起的免疫抑制而导致的一种已被充分证实的并发症。研究表明，HBVr 与免疫抑制药物有关，如利妥昔单抗、甲氨蝶呤和大剂量类固醇。不同类型的化疗药物有不同的风险，其中利妥昔单抗的风险最高之一。酪氨酸激酶抑制剂（TKIs）是慢性髓性白血病（CML）患者的标准治疗方法。HBVr 的风险在许多研究中都有报道，但迄今为止，对于接受 TKI 治疗的 CML 患者的 HBV 筛查和监测，尚无明确的指南或建议。我们进行了这项综述，以确定接受酪氨酸激酶抑制剂治疗的 CML 患者的 HBVr 风险。我们建议对接受 TKI 治疗的患者进行 HBV 状态检测，并考虑对 HBsAg 阳性的患者进行预防治疗。需要更多的研究来评估乙型肝炎核心抗体阳性患者接受 TKI 治疗后的再激活风险。目前，对这些患者进行再激活监测可能是最佳策略。
