TY - JOUR
T1 - Impact of the timing of hepatitis B virus identification and anti–hepatitis B virus therapy initiation on the risk of adverse liver outcomes for patients receiving cancer therapy
AU - Hwang, Jessica P.
AU - Suarez-Almazor, Maria E.
AU - Cantor, Scott B.
AU - Barbo, Andrea
AU - Lin, Heather Y.
AU - Ahmed, Sairah
AU - Chavez-MacGregor, Mariana
AU - Donato-Santana, Christian
AU - Eng, Cathy
AU - Ferrajoli, Alessandra
AU - Fisch, Michael J.
AU - McLaughlin, Peter
AU - Simon, George R.
AU - Rondon, Gabriela
AU - Shpall, Elizabeth J.
AU - Lok, Anna S.
N1 - Publisher Copyright:
© 2017 American Cancer Society
PY - 2017/9/1
Y1 - 2017/9/1
N2 - BACKGROUND: Data on the incidence of adverse liver outcomes are limited for cancer patients with chronic (hepatitis B surface antigen [HBsAg]–positive/hepatitis B core antibody [anti-HBc]–positive) or past (HBsAg-negative/anti-HBc–positive) hepatitis B virus (HBV) after chemotherapy. This study was aimed at determining the impact of test timing and anti-HBV therapy on adverse liver outcomes in these patients. METHODS: Patients with solid or hematologic malignancies who received chemotherapy between 2004 and 2011 were retrospectively studied. HBV testing and anti-HBV therapy were defined as early at the initiation of cancer therapy and as late after initiation. Outcomes included hepatitis flares, hepatic impairment, liver failure, and death. Time-to-event analysis was used to determine incidence, and multivariate hazard models were used to determine predictors of outcomes. RESULTS: There were 18,688 study patients (80.4% with solid tumors). The prevalence of chronic HBV was 1.1% (52 of 4905), and the prevalence of past HBV was 7.1% (350 of 4905). Among patients with solid tumors, late identification of chronic HBV was associated with a higher risk of hepatitis flare (hazard ratio [HR], 4.02; 95% confidence interval [CI], 1.26-12.86), hepatic impairment (HR, 8.48; 95% CI, 1.86-38.66), liver failure (HR, 9.38; 95% CI, 1.50-58.86), and death (HR, 3.90; 95% CI, 1.19-12.83) in comparison with early identification. Among patients with hematologic malignancies and chronic HBV, the risk of death was 7.8 (95% CI, 1.73-35.27) times higher for persons with late initiation of anti-HBV therapy versus early initiation. Patients with late identification of chronic HBV had late or no anti-HBV therapy. Chronic HBV predicted liver failure in patients with solid or hematologic malignancies, whereas male sex and late identification were predictors for patients with solid tumors. CONCLUSIONS: Early identification correlates with early anti-HBV therapy and reduces the risk of liver failure and death in chronic HBV patients receiving chemotherapy. Cancer 2017;123:3367-76.
AB - BACKGROUND: Data on the incidence of adverse liver outcomes are limited for cancer patients with chronic (hepatitis B surface antigen [HBsAg]–positive/hepatitis B core antibody [anti-HBc]–positive) or past (HBsAg-negative/anti-HBc–positive) hepatitis B virus (HBV) after chemotherapy. This study was aimed at determining the impact of test timing and anti-HBV therapy on adverse liver outcomes in these patients. METHODS: Patients with solid or hematologic malignancies who received chemotherapy between 2004 and 2011 were retrospectively studied. HBV testing and anti-HBV therapy were defined as early at the initiation of cancer therapy and as late after initiation. Outcomes included hepatitis flares, hepatic impairment, liver failure, and death. Time-to-event analysis was used to determine incidence, and multivariate hazard models were used to determine predictors of outcomes. RESULTS: There were 18,688 study patients (80.4% with solid tumors). The prevalence of chronic HBV was 1.1% (52 of 4905), and the prevalence of past HBV was 7.1% (350 of 4905). Among patients with solid tumors, late identification of chronic HBV was associated with a higher risk of hepatitis flare (hazard ratio [HR], 4.02; 95% confidence interval [CI], 1.26-12.86), hepatic impairment (HR, 8.48; 95% CI, 1.86-38.66), liver failure (HR, 9.38; 95% CI, 1.50-58.86), and death (HR, 3.90; 95% CI, 1.19-12.83) in comparison with early identification. Among patients with hematologic malignancies and chronic HBV, the risk of death was 7.8 (95% CI, 1.73-35.27) times higher for persons with late initiation of anti-HBV therapy versus early initiation. Patients with late identification of chronic HBV had late or no anti-HBV therapy. Chronic HBV predicted liver failure in patients with solid or hematologic malignancies, whereas male sex and late identification were predictors for patients with solid tumors. CONCLUSIONS: Early identification correlates with early anti-HBV therapy and reduces the risk of liver failure and death in chronic HBV patients receiving chemotherapy. Cancer 2017;123:3367-76.
KW - antiviral therapy
KW - cancer
KW - hematologic malignancies
KW - hepatitis B
KW - hepatitis B reactivation
KW - hepatitis B screening
KW - hepatitis flare
KW - liver failure
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U2 - 10.1002/cncr.30729
DO - 10.1002/cncr.30729
M3 - Article
C2 - 28518219
AN - SCOPUS:85027533815
SN - 0008-543X
VL - 123
SP - 3367
EP - 3376
JO - Cancer
JF - Cancer
IS - 17
ER -