title: Risk factors and outcomes of hepatitis B virus reactivation in hepatitis B surface antigen negative patients with hematological malignancies.
abstract: OBJECTIVE
  Current guidelines recommend all patients scheduled to receive chemotherapy should be screened for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B virus core antigen (anti-HBc) status. However, still, more research is needed to identify the risk factors for hepatitis B virus (HBV) reactivation. We retrospectively investigated the incidence, risk factors and outcome of HBV reactivation in HBsAg negative patients with hematological malignancies.
  
  
  METHODS
  Seven hundred and thirty-eight HBsAg negative patients with hematological malignancies were included in the study. HBV reactivation was defined as reverse seroconversion of HBsAg (HBsAg reappearance). Risk factors, cumulative incidence and overall survival of HBV reactivation were analyzed.
  
  
  RESULTS
  Reactivation occurred in 23 of the 738 (3.1%) enrolled patients. As expected, the reactivation rate of the anti-HBc positive group was significantly higher than that of the anti-HBc negative group (5.4% vs 0.8%). Multivariate analysis indicated that loss of antibody to the hepatitis B surface antigen (anti-HBs) was an independent risk factor. Patients with acute lymphoblastic leukemia and multiple myeloma showed significantly higher reactivation rate than those with other diseases. The cumulative incidence of HBV reactivation after starting chemotherapy in the anti-HBc positive subgroup was 0.3% at 1 year, 1.7% at 2 years and 10.5% at 3 years.
  
  
  CONCLUSIONS
  Close monitoring of HBV markers, including anti-HBs, should be performed for longer than 24 months. Further study is needed to establish a strategy to prevent HBV reactivation after chemotherapy in HBsAg negative patients with hematological malignancies.
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Han
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Yang
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Hae Lim
authors.initials: HL
authors.lastname: Lee
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Division of Hematology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Jong-Wook
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Division of Hematology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Hee Je
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Division of Hematology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Seok
authors.initials: S
authors.lastname: Lee
authors.affiliation: Division of Hematology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Seok Goo
authors.initials: SG
authors.lastname: Cho
authors.affiliation: Division of Hematology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Min
authors.affiliation: Division of Hematology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, Korea.
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
keywords: antibody to hepatitis B surface antigen; antibody to hepatitis B virus core antigen; chemotherapy; hematological malignancy; hepatitis B virus; viral reactivation