Management of Hepatitis B Virus Reactivation after the Completion of Cancer Chemotherapy using a Plan-do-Check-Act Cycle

• Satoshi Hibi

  Department of Hospital Pharmacy, Nagoya Memorial Hospital, Japan and Chemotherapy Team, Nagoya Memorial Hospital, Japan

• Kenji Ina

  Department of Geriatric Medicine, Shinseikai Dai-ichi Hospital, Nagoya, Japan

• Shu Yuasa

  Department of Hospital Pharmacy, Nagoya Memorial Hospital, Japan

• Nobuto Ito

  Department of Hospital Pharmacy, Nagoya Memorial Hospital, Japan

• Yuko Shirokawa

  Department of Nursing, Nagoya Memorial Hospital, Japan and Chemotherapy Team, Nagoya Memorial Hospital, Japan

• Kengo Nanya

  Department of Clinical Laboratory, Nagoya Memorial Hospital, Japan

• Yuko Kato

  Medical Social Work Consultation Room, Nagoya Memorial Hospital, Japan

• Takashi Yoshida

  Department of Clinical Oncology, Nagoya Memorial Hospital, Japan and Chemotherapy Team, Nagoya Memorial Hospital, Japan

• Satoshi Kayukawa

  Department of Clinical Oncology, Nagoya Memorial Hospital, Japan and Chemotherapy Team, Nagoya Memorial Hospital, Japan

The reactivation of the hepatitis B virus (HBV) following systemic chemotherapy reportedly caused acute liver dysfunction as a fatal complication. HBV reactivation sometimes occurs even after the cessation of chemotherapy, especially in the patients with hematological malignancies. A retrospective survey of patients with hepatitis B surface (HBs) antigen-negative cancer with HBs and/or HBc antibodies was conducted by a multidisciplinary chemotherapy team to determine the examination rate of the HBV DNA test after the completion of chemotherapy. Among 83 patients with a resolved HBV infection, who were followed up for more than 3 months, only 17 patients underwent HBV DNA monitoring every 1-3 months (17/83; 20.5%). Since September, 2022, the chemotherapy team has informed the attending physician regarding the continuous HBV DNA monitoring in patients with cancer with a resolved HBV infection until 12 months after the cessation of chemotherapy.

Kusumoto S, Tanaka Y, Suzuki R, et al. Monitoring of hepatitis B virus (HBV) DNA and risk of HBV reactivation in B-cell lymphoma: A prospective observational study. Clin Infect Dis 2015; 61: 719-29. https://doi.org/10.1093/cid/civ344

Yamauchi N, Maruyama D, Choi I, et al. Prophylactic antiviral therapy for hepatitis B virus surface antigen-positive patients with diffuse large B-cell lymphoma treated with rituximab-containing chemotherapy. Cancer Sci 2021; 112: 1943-54. https://doi.org/10.1111/cas.14846

Kikuchi T, Kusumoto S, Tanaka Y, et al. Hepatitis B virus reactivation in a myeloma patient with resolved infection who received daratumumab-containing salvage chemotherapy. J Clin Exp Hematol 2020; 60: 51-4. https://doi.org/10.3960/jslrt.19034

Loomba R, Liang TJ. Hepatitis B reactivation associated with immune suppressive and biological modifier therapies: current concepts, management strategies, and future directions. Gastroenterology 2017; 152: 1297-309. https://doi.org/10.1053/j.gastro.2017.02.009

Yeo W, Chan TC, Leung NWY, et al. Hepatitis B virus reactivation in lymphoma patients with prior resolved hepatitis B undergoing anticancer therapy with or without rituximab. J Clin Oncol 2009; 27: 605-11. https://doi.org/10.1200/JCO.2008.18.0182

Drafting committee for hepatitis management guidelines, the Japan Society of Hepatology. Japan Society of Hepatology guidelines for the management of hepatitis B virus infection: 2019 update. Hepatol Res 2020; 50: 892-923. https://doi.org/10.1111/hepr.13504

Hibi S, Ina K, Kabeya M, Inoue H, Shirokawa Y, Yuasa S. Quality and safety improvement in cancer chemotherapy using the Plan-Do-Check-Act cycle. Indian J Appl Res 2015; 12: 140-1.

Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452-8. https://doi.org/10.1038/bmt.2012.244

Yeo W, Zee B, Zhong S, et al. Comprehensive analysis of risk factors associating with hepatitis B virus (HBV) reactivation in cancer patients undergoing cytotoxic chemotherapy. Br J Cancer 2004; 90: 1306-11.

https://doi.org/10.1038/sj.bjc.6601699

Kim HY, Kim W. Chemotherapy-related reactivation of hepatitis B infection: updates in 2013. World J Gastroenterol. 2014; 20: 14581-8.

https://doi.org/10.3748/wjg.v20.i40.14581

Evens AM, Jovanovic BD, Su Y-C, et al. Rituximab-associated hepatitis B virus (HBV) reactivation in lymphoproliferative diseases: meta-analysis and examination of FDA safety reports. Ann Oncol 2011; 22: 1170-80.

https://doi.org/10.1093/annonc/mdq583

• PDF

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.