High risk of hepatitis B reactivation among patients with acute myeloid leukemia
Journal
PLoS ONE
Journal Volume
10
Journal Issue
5
Date Issued
2015
Author(s)
Abstract
Background: Hepatitis B virus (HBV) infections are common and associated with significant morbidity and mortality in cancer patients. However, the incidence and risk factors of HBV reactivation in patients with acute myeloid leukemia (AML) are rarely investigated. Methods: AML patients followed-up at the National Taiwan University Hospital between 2006 and 2012 were analyzed. The clinical characteristics and laboratory data were retrospectively reviewed. Results: Four hundred and ninety patients comprising 265 men and 225 women were studied. The median age was 52 years (range, 18-94). Chronic HBV carriage was documented at the time of leukemia diagnosis in 57 (11.6%) patients. Forty-six (80.7%) of the 57 HBV carriers received prophylaxis with anti-HBV agents. Sixteen HBV carriers (28.1%) developed hepatitis B reactivation during or after chemotherapy, including 7 patients who had discontinued antiviral therapy. The incidence of hepatitis B reactivation among AML patients with HBV carriage was 9.5 per 100 person-years. Prophylaxis with anti-HBV agents significantly decreased the risk of hepatitis B reactivation among HBV carriers (13% vs. 61%, p<0.001). Four (2.8%) of 142 patients with initial positive anti-HBsAb and anti-HBcAb experienced hepatitis B reactivation and lost their protective anti-HBsAb. Multivariate analysis revealed that diabetes mellitus (p=0.008, odds ratio (OR) = 2.841, 95% confident interval (CI): 0.985-8.193) and carriage of HBsAg (p<0.001, OR=36.878, 95% CI: 11.770-115.547) were independent risk factors for hepatitis B reactivation in AML patients. Conclusions: Hepatitis B reactivation is not uncommon in the HBsAg positive AML patients. Prophylaxis with anti-HBV agent significantly decreased the risk of hepatitis B reactivation. ? 2015 Chen et al.
SDGs
Other Subjects
adefovir; anthracycline derivative; azacitidine; cytarabine; entecavir; hepatitis B core antibody; hepatitis B surface antibody; hepatitis B surface antigen; hepatitis B vaccine; lamivudine; methylprednisolone; retinoic acid; telbivudine; tenofovir; antineoplastic agent; antivirus agent; virus antibody; acute myeloblastic leukemia; adult; aged; Article; cancer survival; clinical feature; continuous infusion; diabetes mellitus; drug megadose; female; fever; follow up; hematopoietic stem cell transplantation; hepatitis B; Hepatitis B virus; human; incidence; laboratory test; low drug dose; major clinical study; male; multivariate analysis; patient compliance; promyelocytic leukemia; prophylaxis; rash; retrospective study; risk assessment; risk factor; risk reduction; Taiwan; university hospital; very elderly; virus carrier; virus reactivation; adolescent; blood; complication; drug effects; hepatitis B; isolation and purification; Leukemia, Myeloid, Acute; middle aged; virology; virus activation; young adult; Hepatitis B virus; Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Viral; Antineoplastic Agents; Antiviral Agents; Female; Follow-Up Studies; Hepatitis B; Hepatitis B virus; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Taiwan; Virus Activation; Young Adult
Publisher
Public Library of Science
Type
journal article