Hepatitis B reactivation among 1962 patients with hematological malignancy in Taiwan.

ABSTRACT

BACKGROUND: The risk of Hepatitis B virus (HBV) reactivation in patients with different hematological malignancy except lymphoma were rarely known before. METHODS: A total of 1962 patients with hematological malignancy were enrolled and followed-up at the National Taiwan University Hospital between 2008 and 2013. The clinical characteristics, HBV serology, and laboratory data were retrospectively reviewed and analyzed. RESULTS: A total of 1962 patients comprising 1048 men and 914 women were studied. The median age of the patients was 55 years (range, 15-97 years). Chronic HBV carriage was documented at diagnosis of hematological malignancy in 286 (14.6%) patients. A total of 171 (59.8%) of the 286 HBV carriers received primary prophylaxis with anti-HBV agents. Of the HBV carriers, 97 (33.9%) developed hepatitis B reactivation during or after chemotherapy, including 59 patients who had discontinued antiviral therapy. The incidence of hepatitis B reactivation among patients with hematological malignancy and HBV carriage was 10.4 per 100 person-years. A multivariate analysis revealed hepatocellular carcinoma (p < 0.001) and antiviral prophylaxis use (p < 0.001) were independent risk factors of HBV reactivation in HBV carriers. Of the 1676 patients with initial negative hepatitis B surface antigen (HBsAg) counts, 41 (2.4%) experienced hepatitis B reactivation, reverse seroconversion of HBsAg, and lost their protective hepatitis B surface antibody (anti-HBs). A multivariate analysis revealed that diabetes mellitus (p = 0.005, odds ratio (OR) 0.218, 95% confidence interval (CI) 0.076-0.629), allogeneic transplantation (p = 0.013, OR 0.182, 95% CI 0.047-0.701), liver cirrhosis (p < 0.001, OR 0.002, 95% CI 0-0.047), low anti-HBs titers (p = 0.016, OR 0.020, 95% CI 0.001-0.480), and positive hepatitis B core antibody (p = 0.013, OR 0.070, 95% CI 0.009-0.571) were independent risk factors of positive seroconversion of HBsAg in patients with hematological malignancy. CONCLUSIONS: The incidence of HBV reactivation among the patients with varying subtypes of hematological malignancy is similar. Prophylaxis with anti-HBV agents critically reduced the risk of hepatitis B reactivation.