Hepatitis B management during immunosuppression for haematological and solid organ malignancies

an Australian consensus statement

Joseph Doyle, Michelle Raggatt, Monica Slavin, Sue Anne McLachlan, Simone I. Strasser, Joseph J. Sasadeusz, Jessica Howell, Krispin Hajkowicz, Harshal Nandurkar, Anna Johnston, Narin Bak, Alexander J. Thompson

Research output: Contribution to journalArticleOtherpeer-review

2 Citations (Scopus)

Abstract

Introduction: Individuals with chronic hepatitis B virus (HBV) infection or past exposure to HBV infection have a substantial risk of reactivation during immunosuppressive cancer therapy. HBV reactivation can lead to liver failure, cancer treatment interruption or death. Clinical concordance with screening and treatment guidelines is inconsistent in practice, and existing international guidelines are not specific to the Australian context. We developed an Australian consensus statement with infectious diseases, hepatology, haematology and oncology specialists to inform hepatitis B screening and antiviral management for immunocompromised patients with haematological and solid organ malignancies in Australia. Main recommendations: Recommendations address four key areas of HBV infection management for immunocompromised patients with haematological and solid organ malignancies: who to test for HBV infection, when to start antiviral agents, when to stop antiviral agents, and how to monitor patients during cancer therapy. We recommend testing all patients undergoing cancer treatment for hepatitis B (including HBV surface antigen [HBsAg], HBV core antibody [anti-HBc], and HBV surface antibody) before cancer treatment. Individuals with chronic HBV infection (HBsAg positive) or past exposure (HBsAg negative and anti-HBc positive) receiving higher risk chemotherapy require antiviral prophylaxis using entecavir or tenofovir. Changes in management as a result of this statement: This consensus statement will simplify the approach to testing and prophylaxis for HBV infection during cancer therapy, and harmonise approaches to discontinuing and monitoring individuals which have been highly variable in practice. We advocate for broader Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access to HBV testing and treatment for patients undergoing cancer therapy.

Original languageEnglish
Pages (from-to)462-468
Number of pages7
JournalMedical Journal of Australia
Volume210
Issue number10
DOIs
Publication statusPublished - 3 Jun 2019

Keywords

  • Cancer
  • Chemotherapy
  • Hepatitis B
  • Immunosuppression

Cite this

Doyle, Joseph ; Raggatt, Michelle ; Slavin, Monica ; McLachlan, Sue Anne ; Strasser, Simone I. ; Sasadeusz, Joseph J. ; Howell, Jessica ; Hajkowicz, Krispin ; Nandurkar, Harshal ; Johnston, Anna ; Bak, Narin ; Thompson, Alexander J. / Hepatitis B management during immunosuppression for haematological and solid organ malignancies : an Australian consensus statement. In: Medical Journal of Australia. 2019 ; Vol. 210, No. 10. pp. 462-468.
@article{71eb767f90b546efb651c4000e6d64f6,
title = "Hepatitis B management during immunosuppression for haematological and solid organ malignancies: an Australian consensus statement",
abstract = "Introduction: Individuals with chronic hepatitis B virus (HBV) infection or past exposure to HBV infection have a substantial risk of reactivation during immunosuppressive cancer therapy. HBV reactivation can lead to liver failure, cancer treatment interruption or death. Clinical concordance with screening and treatment guidelines is inconsistent in practice, and existing international guidelines are not specific to the Australian context. We developed an Australian consensus statement with infectious diseases, hepatology, haematology and oncology specialists to inform hepatitis B screening and antiviral management for immunocompromised patients with haematological and solid organ malignancies in Australia. Main recommendations: Recommendations address four key areas of HBV infection management for immunocompromised patients with haematological and solid organ malignancies: who to test for HBV infection, when to start antiviral agents, when to stop antiviral agents, and how to monitor patients during cancer therapy. We recommend testing all patients undergoing cancer treatment for hepatitis B (including HBV surface antigen [HBsAg], HBV core antibody [anti-HBc], and HBV surface antibody) before cancer treatment. Individuals with chronic HBV infection (HBsAg positive) or past exposure (HBsAg negative and anti-HBc positive) receiving higher risk chemotherapy require antiviral prophylaxis using entecavir or tenofovir. Changes in management as a result of this statement: This consensus statement will simplify the approach to testing and prophylaxis for HBV infection during cancer therapy, and harmonise approaches to discontinuing and monitoring individuals which have been highly variable in practice. We advocate for broader Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access to HBV testing and treatment for patients undergoing cancer therapy.",
keywords = "Cancer, Chemotherapy, Hepatitis B, Immunosuppression",
author = "Joseph Doyle and Michelle Raggatt and Monica Slavin and McLachlan, {Sue Anne} and Strasser, {Simone I.} and Sasadeusz, {Joseph J.} and Jessica Howell and Krispin Hajkowicz and Harshal Nandurkar and Anna Johnston and Narin Bak and Thompson, {Alexander J.}",
year = "2019",
month = "6",
day = "3",
doi = "10.5694/mja2.50160",
language = "English",
volume = "210",
pages = "462--468",
journal = "Medical Journal of Australia",
issn = "0025-729X",
publisher = "AMPCo",
number = "10",

}

Doyle, J, Raggatt, M, Slavin, M, McLachlan, SA, Strasser, SI, Sasadeusz, JJ, Howell, J, Hajkowicz, K, Nandurkar, H, Johnston, A, Bak, N & Thompson, AJ 2019, 'Hepatitis B management during immunosuppression for haematological and solid organ malignancies: an Australian consensus statement', Medical Journal of Australia, vol. 210, no. 10, pp. 462-468. https://doi.org/10.5694/mja2.50160

Hepatitis B management during immunosuppression for haematological and solid organ malignancies : an Australian consensus statement. / Doyle, Joseph; Raggatt, Michelle; Slavin, Monica; McLachlan, Sue Anne; Strasser, Simone I.; Sasadeusz, Joseph J.; Howell, Jessica; Hajkowicz, Krispin; Nandurkar, Harshal; Johnston, Anna; Bak, Narin; Thompson, Alexander J.

In: Medical Journal of Australia, Vol. 210, No. 10, 03.06.2019, p. 462-468.

Research output: Contribution to journalArticleOtherpeer-review

TY - JOUR

T1 - Hepatitis B management during immunosuppression for haematological and solid organ malignancies

T2 - an Australian consensus statement

AU - Doyle, Joseph

AU - Raggatt, Michelle

AU - Slavin, Monica

AU - McLachlan, Sue Anne

AU - Strasser, Simone I.

AU - Sasadeusz, Joseph J.

AU - Howell, Jessica

AU - Hajkowicz, Krispin

AU - Nandurkar, Harshal

AU - Johnston, Anna

AU - Bak, Narin

AU - Thompson, Alexander J.

PY - 2019/6/3

Y1 - 2019/6/3

N2 - Introduction: Individuals with chronic hepatitis B virus (HBV) infection or past exposure to HBV infection have a substantial risk of reactivation during immunosuppressive cancer therapy. HBV reactivation can lead to liver failure, cancer treatment interruption or death. Clinical concordance with screening and treatment guidelines is inconsistent in practice, and existing international guidelines are not specific to the Australian context. We developed an Australian consensus statement with infectious diseases, hepatology, haematology and oncology specialists to inform hepatitis B screening and antiviral management for immunocompromised patients with haematological and solid organ malignancies in Australia. Main recommendations: Recommendations address four key areas of HBV infection management for immunocompromised patients with haematological and solid organ malignancies: who to test for HBV infection, when to start antiviral agents, when to stop antiviral agents, and how to monitor patients during cancer therapy. We recommend testing all patients undergoing cancer treatment for hepatitis B (including HBV surface antigen [HBsAg], HBV core antibody [anti-HBc], and HBV surface antibody) before cancer treatment. Individuals with chronic HBV infection (HBsAg positive) or past exposure (HBsAg negative and anti-HBc positive) receiving higher risk chemotherapy require antiviral prophylaxis using entecavir or tenofovir. Changes in management as a result of this statement: This consensus statement will simplify the approach to testing and prophylaxis for HBV infection during cancer therapy, and harmonise approaches to discontinuing and monitoring individuals which have been highly variable in practice. We advocate for broader Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access to HBV testing and treatment for patients undergoing cancer therapy.

AB - Introduction: Individuals with chronic hepatitis B virus (HBV) infection or past exposure to HBV infection have a substantial risk of reactivation during immunosuppressive cancer therapy. HBV reactivation can lead to liver failure, cancer treatment interruption or death. Clinical concordance with screening and treatment guidelines is inconsistent in practice, and existing international guidelines are not specific to the Australian context. We developed an Australian consensus statement with infectious diseases, hepatology, haematology and oncology specialists to inform hepatitis B screening and antiviral management for immunocompromised patients with haematological and solid organ malignancies in Australia. Main recommendations: Recommendations address four key areas of HBV infection management for immunocompromised patients with haematological and solid organ malignancies: who to test for HBV infection, when to start antiviral agents, when to stop antiviral agents, and how to monitor patients during cancer therapy. We recommend testing all patients undergoing cancer treatment for hepatitis B (including HBV surface antigen [HBsAg], HBV core antibody [anti-HBc], and HBV surface antibody) before cancer treatment. Individuals with chronic HBV infection (HBsAg positive) or past exposure (HBsAg negative and anti-HBc positive) receiving higher risk chemotherapy require antiviral prophylaxis using entecavir or tenofovir. Changes in management as a result of this statement: This consensus statement will simplify the approach to testing and prophylaxis for HBV infection during cancer therapy, and harmonise approaches to discontinuing and monitoring individuals which have been highly variable in practice. We advocate for broader Medicare Benefits Schedule and Pharmaceutical Benefits Scheme access to HBV testing and treatment for patients undergoing cancer therapy.

KW - Cancer

KW - Chemotherapy

KW - Hepatitis B

KW - Immunosuppression

UR - http://www.scopus.com/inward/record.url?scp=85065547774&partnerID=8YFLogxK

U2 - 10.5694/mja2.50160

DO - 10.5694/mja2.50160

M3 - Article

VL - 210

SP - 462

EP - 468

JO - Medical Journal of Australia

JF - Medical Journal of Australia

SN - 0025-729X

IS - 10

ER -