Chronic hepatitis B and hematological malignancies

A.O. Buyeverov1, P.O. Bogomolov2

1 I.M. Sechenov First Moscow State University, RF Ministry of Health, Moscow, Russian Federation

2 M.F. Vladimirsky Moscow Regional Research-and-Clinical Institute, Moscow, Russian Federation


The active usage of monoclonal antibodies in therapy for hematology malignancies made reactivation of hepatitis B virus (HBV) infection one of the major health problems. Monoclonal antibodies are also used in solid tumors, rheumatic, gastroenterological, and skin diseases. Identification of patients with active, inactive, or latent HBV infection with the high risk of reactivation and appropriate antiviral therapy decreases the risk of liver damage and allows the complete course of cancer treatment. Preventive anti-HBV therapy is based on nucleoside analogues that should be chosen in accordance to their efficacy and considering the risk of resistant viral strain selection during long-term treatment. Existing preventive regimens require improvement that warrants further prospective trials for elaboration of optimal recommendations. Thus, prevention of HBV infection reactivation in patients receiving immunosuppressive drugs should include nucleoside analogues according to the HBV infection phase, as well as the therapeutic regimen and duration of treatment.

Keywords: chronic hepatitis B, immunosuppression, nucleoside analogues, entecavir.

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  1. Рациональная фармакотерапия в гепатологии. Под ред. В.Т. Ивашкина, А.О. Буеверова. М.: Литтерра, 2009. [Ratsionalnaya farmakoterapiya v gepatologii. Pod. red. V.T. Ivashkina, A.O. Buyeverova (Rational drug therapy in hepatology). M.: Litterra, 2009.]
  2. Абдурахманов Д.Т. Хронический гепатит B и D. М.: ГЭОТАР-Медиа, 2010. [Abdurakhmanov D.T. Khronicheskiy gepatit B i D (Chronic hepatitis B and D). M.: GEOTAR-Media, 2010.]
  3. Kuo A., Gish R. Chronic hepatitis B infection. Clin. Liver Dis. 2012; 16(2): 347–69.
  4. Kao J.H. Molecular epidemiology of hepatitis B virus. Korean J. Intern. Med. 2011; 26: 255–61.
  5. McMahon B.J. Natural history of chronic hepatitis B — clinical implications. Medscape J. Med. 2008; 10: 91–8.
  6. Ивашкин В.Т., Воликовский Л.Я., Тесаева Е.В., Буеверов А.О. Первый российский опыт неинвазивной диагностики фиброза печени с помощью аппарата «Фиброскан». Рос. журн. гастроэнтерол. гепатол. колопроктол. 2006; 6: 65–9. [Ivashkin V.T., Volikovsky L.Ya., Tesayeva E.V., Buyeverov A.O. Pervyy rossiyskiy opyt neinvazivnoy diagnostiki fibroza pecheni s pomoshchyu apparata “Fibroskan” (First experience with non-invasive diagnosis of hepatic fibrosis using Fibroscan apparatus). Ros. zhurn. gastroenterol. gepatol. koloproktol. 2006; 6: 65–9.]
  7. Coffin C.S., Fung S.K., Ma M.M. Management of chronic hepatitis B: Consensus guidelines. Can. J. Gastroenterol. 2012; 26(12): 917–38.
  8. EASL Clinical Practice Guidelines: Management of chronic hepatitis B. J. Hepatol. 2009; 50(2): 227–42.
  9. Leung M. Recent data on treatment of chronic hepatitis B with nucleos(t) ide analogues. Hepatol. Int. 2008; 2: 163–78.
  10. Petersen J., Buti M. Considerations for the long-term treatment of chronic hepatitis B with nucleos(t)ide analogs. Expert Rev. Gastroenterol. Hepatol. 2012; 6(6): 683–94.
  11. Chevaliez S., Rodriguez C., Pawlotsky J.M. New virologic tools for management of chronic hepatitis B and C. Gastroenterology 2012; 142(6): 1303–13.
  12. Pol S., Lampertico P. First-line treatment of chronic hepatitis B with entecavir or tenofovir in «real-life’ settings: from clinical trials to clinical practice. J. Viral Hepat. 2012; 19(6): 377–86.
  13. Jardi R., Rodriguez-Frias F., Schaper M. et al. Hepatitis B virus polymerase variants associated with entecavir drug resistance in treatment-naive patients. J. Viral Hepat. 2007; 14: 835–40.
  14. Богомолов П.О., Буеверов А.О., Никитин И.Г. и др. Хронические вирусные гепатиты. В кн.: Консервативное лечение первичного и метаста- тического рака печени. Под ред. В.А. Горбуновой. М.: МИА, 2013: 262–87. [Bogomolov P.O., Buyeverov A.O., Nikitin I.G. i dr. Khronicheskiye virusnyye gepatity. V kn.: Konservativnoye lecheniye pervichnogo i metastaticheskogo raka pecheni. Pod. red. V.A. Gorbunovoy (Chronic viral hepatitis. In: Conservative management of primary and metastatic liver cancer. Ed. by V.A. Gorbunova). M.: MIA, 2013: 262–87.]
  15. Wolfe R.M. Update on adult immunizations. J. Am. Board Fam. Med. 2012; 25(4): 496–510.
  16. Ferri C., Govoni M., Calabrese L. The A, B, Cs of viral hepatitis in the biologic era. Curr. Opin. Rheumatol. 2010; 22: 443–50.
  17. Francisci D., Falcinelli F., Schiaroli E. et al. Management of hepatitis B virus reactivation in patients with hematological malignancies treated with chemotherapy. Infection 2010; 38: 58–61.
  18. Mastroianni C.M., Lichtner M., Citton R. et al. Current trends in management of hepatitis B virus reactivation in the biologic therapy era. World J. Gastroenterol. 2011; 17(34): 3881–7.
  19. Lok A.S.F., Ward J.W., Perrillo R.P. et al. Reactivation of Hepatitis B during immunosuppressive therapy: potentially fatal yet preventable. Ann. Intern. Med. 2012; 156(10): 743–45.
  20. Fallahian F., Alavian S.M., Fallahian V., Zamani F. Impact of immunosuppression and chemotherapy on reactivation of viral hepatitis. Saudi J. Kidney Dis. Transpl. 2010; 21(4): 621–7.
  21. Pei S.N., Chen C.H., Lee C.M. et al. Reactivation of hepatitis B virus following rituximab-based regimens: a serious complication in both HBsAgpositive and HBsAg-negative patients. Ann. Hematol. 2010; 89: 255–62.
  22. Rago A., Ridola L., Lichtner M. et al. Hepatitis B reactivation despite entecavir prophylaxis in a patient with chronic lymphocytic leukaemia receiving bendamustine. J. Antimicrob. Chemother. 2012; 67(2): 5101.
  23. Wallis R.S. Infectious complications of tumor necrosis factor blockade. Curr. Opin. Infect. Dis. 2009; 22: 403–9.
  24. Aksoy S., Dizdar O., Hayran M., Harputluoglu H. Infectious complications of rituximab in patients with lymphoma during maintenance therapy: a systematic review and meta-analysis. Leuk. Lymphoma 2009; 50: 357–65.
  25. Iannitto E., Minardi V., Calvaruso G. et al. Hepatitis B virus reactivation and alemtuzumab therapy. Eur. J. Haematol. 2005; 74: 254–8.
  26. Elter T., Vehreschild J.J., Gribben J. et al. Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab. Ann. Hematol. 2009; 88: 121–32.
  27. Carroll M.B., Forgione M.A. Use of tumor necrosis factor alpha inhibitors in hepatitis B surface antigen-positive patients: a literature review and potential mechanisms of action. Clin. Rheumatol. 2010; 29: 1021–9.
  28. Kim Y.J., Bae S.C., Sung Y.K. Possible reactivation of potential hepatitis B virus occult infection by tumor necrosis factor-alpha blocker in the treatment of rheumatic diseases. J. Rheumatol. 2010; 37: 346–50.
  29. Moses S.E., Lim Z.Y., Sudhanva M. et al. Lamivudine prophylaxis and treatment of hepatitis B virus-exposed recipients receiving reduced intensity conditioning hematopoietic stem cell transplants with alemtuzumab. J. Med. Virol. 2006; 78: 1560–3.
  30. Marzano A., Angelucci E., Andreone P. et al. Prophylaxis and treatment of hepatitis B in immunocompromised patients. Dig. Liver Dis. 2007; 39: 397–408.
  31. Wong V.W., Wong G.L., Yiu K.K. et al. Entecavir treatment in patients with severe acute exacerbation of chronic hepatitis B. J. Hepatol. 2011; 54: 236–42.
  32. Lai C.L., Shouval D., Lok A.S. et al. Entecavir versus lamivudine for patients with HВeAg-negative chronic hepatitis B. New Engl. J. Med. 2006; 354: 1011–26.
  33. Colson P., Borentain P., Coso D. et al. Entecavir as a first-line treatment for HBV reactivation following polychemotherapy for lymphoma. Br. J. Haematol. 2008; 143: 148–50.