Faculty of Pharmacy, Aix-Marseille Université, Marseille, France.
Department of Pharmacy, Centre Hospitalier de L'Université de Montréal (CHUM), 1050 Sanguinet St, Montréal, QC, Canada.
Support Care Cancer. 2024 Jul 24;32(8):541. doi: 10.1007/s00520-024-08750-6.
Hepatitis B virus (HBV) reactivation (HBVr) induced by chemotherapy in patients with resolved or chronic infection can lead to severe consequences. Despite recommendations, rates of HBV screening before chemotherapy are low due to poor recognition of risk factors by clinicians. The aim of the study is to assess whether routine HBV screening using universal HBV screening on chemotherapy orders (CO) could reduce HBVr incidence.
This is a 1-year retrospective single-center observational study of patients who received intravenous chemotherapy post implementation of CO. We compared the incidence of HBVr in three groups of patients: those screened through CO (group 1), those screened by the medical team (group 2), and those not screened (group 3).
On a total of 1374 patients, 179 of 206 patients were screened as requested on CO (group 1) and 421 by the medical team (group 2), whereas 747 patients were not screened (group 3). Only one HBVr occurred, and no difference was seen on the incidence of HBVr between group 1 and group 3 (0% vs 0.1%; p = 1.00), probably because of a lack of follow-up after chemotherapy. Follow-up for HBVr was imperfect in group 1 and group 2 (16.7% vs 5.6%; p = 0.32). Screening was done for 92% of patients on anti-CD20 therapy. In group 3, 89 patients had ALT elevation during chemotherapy but only 17 (19%) were tested for HBVr.
Systematic HBV detection requested on CO is an effective way to obtain a high percentage of patients with adequate screening, particularly when chemotherapy is at high risk of HBVr. Nevertheless, this screening method do not guarantee optimal follow-up and requires improvements.
在已痊愈或慢性感染的患者中，化疗引起的乙型肝炎病毒（HBV）再激活（HBVr）可能导致严重后果。尽管有相关建议，但由于临床医生对危险因素的认识不足，接受化疗的患者HBV 筛查率仍然较低。本研究旨在评估在化疗医嘱（CO）中常规进行 HBV 筛查（使用普遍 HBV 筛查）是否可以降低 HBVr 的发生率。
这是一项为期 1 年的回顾性单中心观察性研究，纳入了实施 CO 后接受静脉化疗的患者。我们比较了三组患者的 HBVr 发生率：通过 CO 筛查（第 1 组）、通过医疗团队筛查（第 2 组）和未筛查（第 3 组）的患者。
在总共 1374 名患者中，有 206 名患者中的 179 名按 CO 要求筛查（第 1 组），421 名由医疗团队筛查（第 2 组），而 747 名患者未筛查（第 3 组）。仅发生了 1 例 HBVr，第 1 组和第 3 组之间 HBVr 的发生率无差异（0%比 0.1%；p=1.00），这可能是因为化疗后缺乏随访。第 1 组和第 2 组的 HBVr 随访均不完善（16.7%比 5.6%；p=0.32）。有 92%接受抗 CD20 治疗的患者进行了筛查。第 3 组中，有 89 名患者在化疗期间出现 ALT 升高，但仅 17 名（19%）进行了 HBVr 检测。
在 CO 中系统地检测 HBV 是获得足够筛查患者的高比例的有效方法，特别是在化疗有 HBVr 高风险时。然而，这种筛查方法并不能保证最佳的随访，还需要改进。
