| 1 | Prevention and management of hepatitis B virus reactivation in patients with hematological malignancies treated with anticancer therapy显示文摘Hepatitis due to hepatitis B virus(HBV) reactivation can be severe and potentially fatal, but is preventable. HBV reactivation is most commonly reported in patients receiving cancer chemotherapy, especially rituximabcontaining therapy for hematological malignancies and those receiving stem cell transplantation. All patients with hematological malignancies receiving anticancer therapy should be screened for active or resolved HBV infection by blood tests for hepatitis B surface antigen(HBs Ag) and antibody to hepatitis B core antigen(antiHBc). Patients found to be positive for HBs Ag should be given prophylactic antiviral therapy to prevent HBV reactivation. For patients with resolved HBV infection, no standard strategy has yet been established to prevent HBV reactivation. There are usually two options. One is pre-emptive therapy guided by serial HBV DNA monitoring, whereby antiviral therapy is given as soon as HBV DNA becomes detectable. However, there is little evidence regarding the optimal interval and period of monitoring. An alternative approach is prophylactic antiviral therapy, especially for patients receiving highrisk therapy such as rituximab, newer generation of anti-CD20 monoclonal antibody, obinutuzumab or hematopoietic stem cell transplantation. This strategy may effectively prevent HBV reactivation and avoid the inconvenience of repeated HBV DNA monitoring. Entecavir or tenofovir are preferred over lamivudine as prophylactic therapy. Although there is no well-defined guideline on the optimal duration of prophylactic therapy, there is growing evidence to recommend continuing prophylactic antiviral therapy for at least 12 mo after cessation of chemotherapy, and even longer for those who receive rituximab or who had high serum HBV DNA levels before the start of immunosuppressive therapy. Many novel agents have recently become available for the treatment of hematological malignancies, and these agents may be associated with HBV reactivation. Although there is currently limited evidence to guide the optimal preventive measures, we recommend antiviral prophylaxis in HBs Ag-positive patients receiving novel treatments, especially the Bruton tyrosine kinase inhibitors and the phosphatidylinositol 3-kinase inhibitors, which are B-cell receptor signaling modulators and reduce proliferation of malignant B-cells. Further studies are needed to clarify the risk of HBV reactivation with these agents and the best prophylactic strategy in the era of targeted therapy for hematological malignancies. | Man Fai Law Rita Ho Carmen KM Cheung Lydia HP Tam Karen Ma Kent CY So Bonaventure Ip Jacqueline So Jennifer Lai Joyce Ng Tommy HC Tam | 2016 | World Journal of Gastroenterology2016，22，28： | 10 |
| 2 | Veterans health administration hepatitis B testing and treatment with anti-CD20 antibody administration显示文摘AIM: To evaluate pretreatment hepatitis B virus(HBV) testing, vaccination, and antiviral treatment rates in Veterans Affairs patients receiving anti-CD20 Ab for quality improvement.METHODS: We performed a retrospective cohort study using a national repository of Veterans Health Administration(VHA) electronic health record data. We identified all patients receiving anti-CD20 Ab treatment(2002-2014). We ascertained patient demographics, laboratory results, HBV vaccination status(from vaccination records), pharmacy data, and vital status. The high risk period for HBV reactivation is during antiCD20 Ab treatment and 12 mo follow up. Therefore, we analyzed those who were followed to death or for at least 12 mo after completing anti-CD20 Ab. Pretreatment serologic tests were used to categorize chronic HBV(hepatitis B surface antigen positive or HBs Ag+), past HBV(HBs Ag-, hepatitis B core antibody positive or HBc Ab+), resolved HBV(HBs Ag-, HBc Ab+, hepatitis B surface antibody positive or HBs Ab+), likely prior vaccination(isolated HBs Ab+), HBV negative(HBs Ag-, HBc Ab-), or unknown. Acute hepatitis B was defined by the appearance of HBs Ag+ in the high risk period in patients who were pretreatment HBV negative. We assessed HBV antiviral treatment and the incidence of hepatitis, liver failure, and death during the high risk period. Cumulative hepatitis, liver failure, and death after anti-CD20 Ab initiation were compared by HBV disease categories and differences compared using the χ2 test. Mean time to hepatitis peak alanine aminotransferase, liver failure, and death relative to anti-CD20 Ab administration and follow-up were also compared by HBV disease group.RESULTS: Among 19304 VHA patients who received anti-CD20 Ab, 10224(53%) had pretreatment HBs Ag testing during the study period, with 49% and 43% tested for HBs Ag and HBc Ab, respectively within 6 mo pretreatment in 2014. Of those tested, 2%(167/10224) had chronic HBV, 4%(326/7903) past HBV, 5%(427/8110) resolved HBV, 8%(628/8110) likely prior HBV vaccination, and 76%(6022/7903) were HBV negative. In those with chronic HBV infection, ≤ 37% received HBV antiviral treatment during the high risk period while 21% to 23% of those with past or resolved HBV, respectively, received HBV antiviral treatment. During and 12 mo after anti-CD20 Ab, the rate of hepatitis was significantly greater in those HBV positive vs negative(P = 0.001). The mortality rate was 35%-40% in chronic or past hepatitis B and 26%-31% in hepatitis B negative. In those pretreatment HBV negative, 16(0.3%) developed acute hepatitis B of 4947 tested during anti-CD20 Ab treatment and followup. CONCLUSION: While HBV testing of Veterans has increased prior to anti-CD20 Ab, few HBV+ patients received HBV antivirals, suggesting electronic health record algorithms may enhance health outcomes. | Christine M Hunt Lauren A Beste Elliott Lowy Ayako Suzuki Cynthia A Moylan Hans L Tillmann George N Ioannou Joseph K Lim Michael J Kelley Dawn Provenzale | 2016 | World Journal of Gastroenterology2016，22，19： | 1 |
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