title: Risk of hepatitis B infection in pediatric acute lymphoblastic leukemia in a tertiary care center from South India.
abstract: BACKGROUND
  The prevalence of hepatitis B virus (HBV) infection is high in Asian countries. Little is known about outcome of leukemia in HBV infected patients in these regions. Hence, we conducted this study in two cohorts of patients.
  
  
  METHODS
  We retrospectively evaluated mortality, reduction in dose intensity and duration of therapy (intensive phase and maintenance phase) in children with acute lymphoblastic leukemia (ALL) who developed HBV infection. Sixty-three patients with ALL were included in the retrospective cohort of the study. These were followed up for a minimum of 5 years. We prospectively investigated the prevalence of anti-HBc antibodies in 105 treatment naïve pediatric patients with ALL and negative for HbsAg.
  
  
  RESULTS
  Twenty of the 63 patients developed hepatitis, of which 10 were attributed to HBV. All the 10 patients with HBV hepatitis had significantly reduced dose intensity during maintenance therapy with an average delay in completion of therapy of 140 ± 83 days and also a high mortality (40%). In the prospective cohort of the study, 39% of treatment naive patients who were HBsAg negative were anti-HBc positive at presentation, possibly reflecting occult HBV infection.
  
  
  CONCLUSIONS
  HBV infection poses a serious problem in patients with ALL. Hence we propose that in India, in addition to screening for HBsAg, patients with leukemia should also be screened for anti-HBc. Improved hepatitis B vaccine coverage in the community under the universal immunization programme and introduction of HBV nucleic acid test (NAT) for blood donations should also help in addressing the problem.
authors.affiliation: Department of Paediatric Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India.
authors.forename: B
authors.initials: B
authors.lastname: Guruprasad
authors.forename: S
authors.initials: S
authors.lastname: Kavitha
authors.forename: B S
authors.initials: BS
authors.lastname: Aruna Kumari
authors.forename: B R
authors.initials: BR
authors.lastname: Vijaykumar
authors.forename: B G
authors.initials: BG
authors.lastname: Sumati
authors.forename: Sinha
authors.initials: S
authors.lastname: Mahua
authors.forename: L
authors.initials: L
authors.lastname: Appaji
authors.forename: R S
authors.initials: RS
authors.lastname: Jayshree
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006510:Hepatitis B Antibodies / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000821:virology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000401:mortality / Q000821:virology; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers
chemical_list: D006510:Hepatitis B Antibodies; D018937:Hepatitis C Antibodies
keywords: hematology/oncology; hepatitis B; leukemia; pediatric all; viral infection