Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 8, 2017; 9(25): 1043-1053
Published online Sep 8, 2017. doi: 10.4254/wjh.v9.i25.1043
Hepatitis B in patients with hematological diseases: An update
Chiara Coluccio, Paola Begini, Alfredo Marzano, Adriano Pellicelli, Barbara Imperatrice, Giulia Anania, Gianfranco Delle Fave, Massimo Marignani
Chiara Coluccio, Paola Begini, Barbara Imperatrice, Giulia Anania, Gianfranco Delle Fave, Massimo Marignani, Digestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, 00189 Rome, Italy
Alfredo Marzano, Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital, 10126 Turin, Italy
Adriano Pellicelli, Liver Unit, San Camillo Forlanini Hospital, 00152 Rome, Italy
Author contributions: All authors contributed to this paper.
Conflict-of-interest statement: The authors have no disclosures to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Chiara Coluccio, MD, Digestive and Liver Diseases Department, Sant’Andrea Hospital, School of Medicine and Psychology, Sapienza University, Azienda Ospedaliera Sant’Andrea Via Grottarossa, 1035-1039, 00189 Rome, Italy.
Telephone: +39-6-33775691 Fax: +39-6-33775526
Received: May 27, 2017
Peer-review started: June 1, 2017
First decision: July 11, 2017
Revised: July 20, 2017
Accepted: August 3, 2017
Article in press: August 4, 2017
Published online: September 8, 2017

Hepatitis B virus (HBV) reactivation (HBVr) in patients undergoing immunosuppressive therapy is still a hot topic worldwide. Its prevention and management still represents a challenge for specialists dealing with immunosuppressed patients. Aim of this paper is to provide a critical review of the relevant information emerged in the recent literature regarding HBV reactivation following immunosuppressive treatments for oncohematological tumors. A computerized literature search in MEDLINE was performed using appropriate terms arrangement, including English-written literature only or additional relevant articles. Articles published only in abstract form and case reports not giving considerable news were excluded. Clinical manifestation of HBVr can be manifold, ranging from asymptomatic self-limiting anicteric hepatitis to life-threatening fulminant liver failure. In clusters of patients adverse outcomes are potentially predictable. Clinicians should be aware of the inherent risk of HBVr among the different virological categories (active carriers, occult HBV carriers and inactive carriers, the most intriguing category), and classes of immunosuppressive drugs. We recommend that patients undergoing immunosuppressive treatments for hematological malignancies should undergo HBV screening. In case of serological sign(s) of current or past infection with the virus, appropriate therapeutic or preventive strategies are suggested, according to both virological categories, risk of HBVr by immunosuppressive drugs and liver status. Either antiviral drug management and surveillance and pre-emptive approach are examined, commenting the current international recommendations about this debated issue.

Keywords: Reactivation, Lymphoma, Hematology, Immunosuppressive therapy, Prophylaxis, Hepatitis B virus, Chemotherapy, Occult/active/inactive carrier, Entecavir, Lamivudine

Core tip: Despite the increasing awareness regarding the issue of hepatitis B virus reactivation (HBVr) in patients undergoing immunosuppressive treatments, there are still some many debated items concerning this potentially fatal but preventable complication. Both hepatitis B surface antigen (HBsAg) patients and subjects with serological signs of previous resolved exposure to the virus (HBsAg negative/anti-core antibody positive patients) are at risk of HBVr. Purpose of our work was to analyze the current international literature and dedicate guidelines, providing evidences and strategies that have been proposed to manage these patients.