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血液系统恶性肿瘤患者化疗后乙肝表面抗体滴度的变化

Change in Hepatitis B Surface Antibody Titers After Chemotherapy in Patients With Hematological Malignancies.

作者信息

Unver Ulusoy Tülay, Tıglıoglu Pınar, Demirköse Hacer, Albayrak Murat, Şencan İrfan

机构信息

Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, TUR.

Department of Infectious Diseases and Clinical Microbiology, Dışkapı Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, TUR.

出版信息

Cureus. 2024 Jan 3;16(1):e51572. doi: 10.7759/cureus.51572. eCollection 2024 Jan.

Abstract

Background The change in hepatitis B surface antibody (anti-HBs) titers after chemotherapy (CT) in patients with hematological malignancy, affecting factors, and its clinical implications have not been sufficiently understood. Therefore, we aim to evaluate the change in anti-HBs titers and hepatitis B virus reactivation (HBVr) after CT. Methods This retrospective study enrolled patients with hematological malignancies who received CT between 2013 and 2021. All patients were followed up for HBVr and a change in anti-HBs titers for one year. Results Overall, 192 patients were included. In total, 33.9% of the patients were anti-HBs (+) and 26% of the patients were anti-HBc (+) ± anti-HBs (+). Hepatitis B virus (HBV) prophylaxis was given to 35 (70%) of 50 Anti-HBc (+) patients. Tenofovir disoproxil fumarate and entecavir prophylaxis were initiated in 25 (71.4%) and 10 (28.6%) patients, respectively. A significant decrease was found in anti-HBs titers of all patients (p=0.017). A significant decrease was also found in anti-HBs titers of HBc IgG (+) patients and those who received four or more courses of CT (p=0.025; p=0.041). HBVr was not diagnosed in any of the patients. Conclusion Chemotherapeutic agents administered for hematological malignancy have serious immunosuppression effects. In these patients, anti-HBs titers may decrease or become negative one year after CT. Anti-HBs titer before CT or its change after CT may not constitute a risk for HBVr patients who received HBV prophylaxis in line with current guidelines and these recommendations.

摘要

背景 血液系统恶性肿瘤患者化疗(CT)后乙肝表面抗体(抗-HBs)滴度的变化、影响因素及其临床意义尚未得到充分了解。因此,我们旨在评估CT后抗-HBs滴度的变化及乙肝病毒再激活(HBVr)情况。方法 本回顾性研究纳入了2013年至2021年间接受CT的血液系统恶性肿瘤患者。所有患者均随访一年,观察HBVr及抗-HBs滴度变化。结果 共纳入192例患者。总体而言,33.9%的患者抗-HBs阳性,26%的患者抗-HBc阳性±抗-HBs阳性。50例抗-HBc阳性患者中有35例(70%)接受了乙肝病毒(HBV)预防。分别有25例(71.4%)和10例(28.6%)患者开始使用富马酸替诺福韦二吡呋酯和恩替卡韦进行预防。所有患者的抗-HBs滴度均显著下降(p = 0.017)。抗-HBc IgG阳性患者及接受四个或更多疗程CT的患者的抗-HBs滴度也显著下降(p = 0.025;p = 0.041)。所有患者均未诊断出HBVr。结论 用于血液系统恶性肿瘤的化疗药物具有严重的免疫抑制作用。在这些患者中,CT后一年抗-HBs滴度可能降低或转为阴性。对于按照现行指南和这些建议接受HBV预防的患者,CT前的抗-HBs滴度或CT后的变化可能不会构成HBVr的风险。

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