title: Role of surface antibody in hepatitis B reactivation in patients with resolved infection and hematologic malignancy: A meta-analysis.
abstract: Patients with resolved hepatitis B virus (HBV) infection who are treated for hematological malignancies remain at risk for HBV reactivation. Because of conflicting studies about whether the antibody to hepatitis B surface antigen (anti-HBs) protects against reactivation in patients with resolved infection (hepatitis B surface antigen negative) receiving chemotherapy for hematological malignancies, we conducted a meta-analysis to determine if anti-HBs reduces HBV reactivation risk. We sought English-language studies through March 1, 2016, in Medline and other sources that examined reactivation in patients with resolved HBV infection receiving chemotherapy for hematologic malignancies. The absolute risks and odds ratio (OR) of reactivation with versus without anti-HBs were estimated in random-effects model meta-analyses. In 20 studies involving 1,672 patients not receiving antiviral prophylaxis, the reactivation risk was 14% (95% confidence interval [CI] 9.4%-19%) in 388 patients who had antibodies to hepatitis B core antigen only versus 5.0% (95% CI 3.0%-7.0%) in 1,284 patients who also had anti-HBs. Anti-HBs reduced reactivation risk with a pooled OR of 0.21 (95% CI 0.14-0.32) versus patients with antibody to hepatitis B core antigen only. Similar results were found when limiting the analysis to rituximab chemotherapy (OR = 0.19, 95% CI 0.11-0.32) and lymphoma (OR = 0.18, 95% CI 0.11-0.28).
  
  
  
  In patients with resolved HBV receiving chemotherapy for hematological malignancies without antiviral prophylaxis, anti-HBs positivity is associated with a decreased risk of reactivation; HBV screening in this patient population should include the routine use of anti-HBs, and those who are anti-HBs-negative should receive antiviral prophylaxis. Future studies should examine the effect of anti-HBs serum titers, the potential role for booster vaccinations, and antiviral prophylaxis prior to chemotherapy in this patient population. (Hepatology 2017;66:379-388).
authors.affiliation: Section of Gastroenterology, Center for Liver Diseases, The University of Chicago Medicine, Chicago, IL.
authors.forename: Sonali
authors.initials: S
authors.lastname: Paul
authors.affiliation: Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Dickstein
authors.affiliation: Division of Gastroenterology, Boston Medical Center, Boston, MA.
authors.forename: Akriti
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Biostatistics, Epidemiology and Research Design (BERD) Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
authors.forename: Norma
authors.initials: N
authors.lastname: Terrin
authors.affiliation: Division of Gastroenterology and Hepatology, Tufts Medical Center, Boston, MA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Viveiros
authors.affiliation: Brown Center for Evidence-Based Medicine, Brown University School of Public Health, Providence, RI.
authors.forename: Ethan M
authors.initials: EM
authors.lastname: Balk
authors.affiliation: Division of Clinical Decision Making, Tufts Medical Center, Boston, MA.
authors.forename: John B
authors.initials: JB
authors.lastname: Wong
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage; D005260:Female; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000187:drug effects / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000187:drug effects / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome; D014775:Virus Activation / Q000187:drug effects* / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; C413685:entecavir; D006147:Guanine