Hepatitis B Virus Reactivation During Chemotherapy: A Systematic Review and Meta-Analysis.
Paul, Sonali.
2015
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Abstract: Screening
and antiviral prophylaxis for hepatitis B virus (HBV) reactivation has become well
established for patients receiving rituximab-based chemotherapy and hematopoietic stem
cell transplants. Chemotherapy regimens for solid tumors also pose a risk for HBV
reactivation, but screening and prophylaxis for this population remains controversial
because of varying reactivation rates ... read moreand insufficient evidence. Consequently, there is
a need to synthesize and compare the existing data. The aim of the current study is to
perform a systematic review and meta-analysis to determine HBV reactivation rates across
common chemotherapy regimens for solid and hematologic malignancies. Studies through
October 1, 2014 that examined HBV reactivation in patients receiving chemotherapy were
collected from MEDLINE, PubMed, Web of Science, Cochrane Central Register of Controlled
Trials, TOXNET, and Scopus. Inclusion criteria included patients with HBV undergoing
chemotherapy for all solid tumors, hematological diseases, and bone marrow
transplantation. The primary outcome was HBV reactivation defined as an increase in HBV
DNA levels from baseline or the re-emergence of surface antigen when previously surface
antigen negative. Risk of reactivation and odds ratio (OR) for prophylaxis used were
estimated with random-effects models. Heterogeneity was assessed with Q and I2
statistics. A total of 1,706 articles were identified though database searches, of which
82 original reports were included in the current meta-analysis: 13 studies included only
solid tumors (12 chronic infection, 1 past infection); 42 studies involved hematological
malignancies (19 chronic infection, 13 past infection, 10 mixed chronic and resolved
HBV); 8 studies included both solid and liquid tumors (7 chronic infection, 1 past
infection); 18 studies involved hematopoietic stem cell transplant (HSCT) (8 chronic
infection, 9 past infection, 1 chronic and past infection); and 1 study included
patients with past infection with liquid tumors undergoing chemotherapy or HSCT. Solid
tumors included cancers of the gastrointestinal tract, breast, lung, head and neck while
liquid tumors were mostly lymphoma and leukemia. The risk of HBV reactivation in the
absence of prophylaxis was highest in patients with chronic HBV and liquid tumors (51%)
or receiving HSCT (54%) and lowest in patients with resolved HBV with hematological
malignancies (5.8%). Those with solid tumors and chronic infection had a 24% risk of HBV
reactivation, which is slightly higher than the risk seen in patients with resolved HBV
receiving HSCT (19%). All analyses had significant heterogeneity. The addition of
anti-viral prophylaxis reduced the risk of HBV reactivation across all categories. The
presence of surface antibody also protected patients with a history of resolved
infection from HBV reactivation for both liquid tumors (OR 0.19, 95% CI 0.09 - 0.39,
p<0.001) and HSCT (OR 0.09, 95% CI 0.02 - 0.33, p<0.001). HBV reactivation occurs
in patients with chronic HBV receiving solid tumor chemotherapy at rates comparable to
other types of immunosuppressive therapy. This patient population merits HBV screening
and antiviral prophylaxis prior to initiation of chemotherapy. Future studies evaluating
the cost-effectiveness of universal screening are
warranted.
Thesis (M.S.)--Tufts University, 2015.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: John Wong.
Committee: Ethan Balk, Norma Terrin, and Kathleen Viveiros.
Keyword: Health sciences.read less - ID:
- qv33s8390
- Component ID:
- tufts:20495
- To Cite:
- TARC Citation Guide EndNote