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Meta-Analysis
. 2020 Mar;21(3):160-169.
doi: 10.1111/1751-2980.12848. Epub 2020 Mar 20.

Prevention of hepatitis B virus reactivation in patients with hematological malignancies and resolved hepatitis B virus infection: a systematic review and meta-analysis

Carmen Ka Man Cheung  1 , Man Fai Law  1 , David Chun Chao  1 , Sunny Hei Wong  2 , Rita Ho  3 , Amelia Chien Wei Chao  1 , Jennifer Wing Yan Lai  1 , Ted Yun Tat Chan  1 , Mark Tsz Kin Tam  1 , Sam Lik Fung Lau  1 , Tommy Ho Chi Tam  1
Affiliations
Meta-Analysis

Prevention of hepatitis B virus reactivation in patients with hematological malignancies and resolved hepatitis B virus infection: a systematic review and meta-analysis

Carmen Ka Man Cheung et al. J Dig Dis. 2020 Mar.

Abstract

Objective: Patients with resolved hepatitis B virus (HBV) infection are at risk of HBV reactivation during treatment for hematological malignancies. We conducted a systematic review and meta-analysis of the data on the efficacy of antiviral prophylaxis for the prevention of HBV reactivation in this group of patients.

Methods: We conducted a systemic literature search of PubMed including MEDLINE and EMBASE databases to 31 January 2019 to identify studies published in English comparing antiviral prophylaxis with no prophylaxis for HBV reactivation in patients treated for hematological malignancies. The search terms used were ("occult hepatitis B" OR "resolved hepatitis B") AND ("reactivation") AND ("haematological malignancy" OR "hematological malignancy" OR "chemotherapy" OR "immunotherapy" OR "chemoimmunotherapy" OR "lymphoma" OR "leukemia" OR "transplant"). The primary outcome was the reactivation of HBV infection. Pooled estimates of relative risk (RR) were calculated.

Results: We identified 13 relevant studies including two randomized controlled trials (RCT), one post hoc analysis from RCT and 10 cohort studies. There was a trend towards a lower rate of HBV reactivation using antiviral prophylaxis, but the difference was not significant (RR 0.57, 95% confidence interval [CI] 0.23-1.40, P = 0.22). When limiting the analysis to the three prospective studies of patients receiving anti-CD20 monoclonal antibodies, we found antiviral prophylaxis was associated with a significantly lower risk of HBV reactivation (RR 0.17, 95% CI 0.06-0.49, P = 0.001).

Conclusion: Antiviral prophylaxis reduced the risk of HBV reactivation in patients receiving anti-CD20 monoclonal antibodies for hematological malignancies but not in a broader group of patients receiving anticancer therapy.

Keywords: antiviral prophylaxis; hematological neoplasms; hepatitis B virus reactivation; meta-analysis; resolved hepatitis B virus infection.

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References

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