Jessica P Hwang1, Maria E Suarez-Almazor1, Scott B Cantor2, Andrea Barbo3, Heather Y Lin3, Sairah Ahmed4, Mariana Chavez-MacGregor2, Christian Donato-Santana1, Cathy Eng5, Alessandra Ferrajoli6, Michael J Fisch7, Peter McLaughlin8, George R Simon9, Gabriela Rondon4, Elizabeth J Shpall4, Anna S Lok10. 1. Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas. 2. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas. 4. Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 6. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas. 7. Medical Oncology, Aim Specialty Health, Deerfield, Illinois. 8. Physicians Network, MD Anderson Cancer Center, The University of Texas MD Anderson Cancer Center, Houston, Texas. 9. Department of Thoracic Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 10. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Data on the incidence of adverse liver outcomes are limited for cancer patients with chronic (hepatitis B surface antigen [HBsAg]-positive/hepatitis B core antibody [anti-HBc]-positive) or past (HBsAg-negative/anti-HBc-positive) hepatitis B virus (HBV) after chemotherapy. This study was aimed at determining the impact of test timing and anti-HBV therapy on adverse liver outcomes in these patients. METHODS: Patients with solid or hematologic malignancies who received chemotherapy between 2004 and 2011 were retrospectively studied. HBV testing and anti-HBV therapy were defined as early at the initiation of cancer therapy and as late after initiation. Outcomes included hepatitis flares, hepatic impairment, liver failure, and death. Time-to-event analysis was used to determine incidence, and multivariate hazard models were used to determine predictors of outcomes. RESULTS: There were 18,688 study patients (80.4% with solid tumors). The prevalence of chronic HBV was 1.1% (52 of 4905), and the prevalence of past HBV was 7.1% (350 of 4905). Among patients with solid tumors, late identification of chronic HBV was associated with a higher risk of hepatitis flare (hazard ratio [HR], 4.02; 95% confidence interval [CI], 1.26-12.86), hepatic impairment (HR, 8.48; 95% CI, 1.86-38.66), liver failure (HR, 9.38; 95% CI, 1.50-58.86), and death (HR, 3.90; 95% CI, 1.19-12.83) in comparison with early identification. Among patients with hematologic malignancies and chronic HBV, the risk of death was 7.8 (95% CI, 1.73-35.27) times higher for persons with late initiation of anti-HBV therapy versus early initiation. Patients with late identification of chronic HBV had late or no anti-HBV therapy. Chronic HBV predicted liver failure in patients with solid or hematologic malignancies, whereas male sex and late identification were predictors for patients with solid tumors. CONCLUSIONS: Early identification correlates with early anti-HBV therapy and reduces the risk of liver failure and death in chronic HBV patients receiving chemotherapy. Cancer 2017;123:3367-76.
BACKGROUND: Data on the incidence of adverse liver outcomes are limited for cancerpatients with chronic (hepatitis B surface antigen [HBsAg]-positive/hepatitis B core antibody [anti-HBc]-positive) or past (HBsAg-negative/anti-HBc-positive) hepatitis B virus (HBV) after chemotherapy. This study was aimed at determining the impact of test timing and anti-HBV therapy on adverse liver outcomes in these patients. METHODS:Patients with solid or hematologic malignancies who received chemotherapy between 2004 and 2011 were retrospectively studied. HBV testing and anti-HBV therapy were defined as early at the initiation of cancer therapy and as late after initiation. Outcomes included hepatitis flares, hepatic impairment, liver failure, and death. Time-to-event analysis was used to determine incidence, and multivariate hazard models were used to determine predictors of outcomes. RESULTS: There were 18,688 study patients (80.4% with solid tumors). The prevalence of chronic HBV was 1.1% (52 of 4905), and the prevalence of past HBV was 7.1% (350 of 4905). Among patients with solid tumors, late identification of chronic HBV was associated with a higher risk of hepatitis flare (hazard ratio [HR], 4.02; 95% confidence interval [CI], 1.26-12.86), hepatic impairment (HR, 8.48; 95% CI, 1.86-38.66), liver failure (HR, 9.38; 95% CI, 1.50-58.86), and death (HR, 3.90; 95% CI, 1.19-12.83) in comparison with early identification. Among patients with hematologic malignancies and chronic HBV, the risk of death was 7.8 (95% CI, 1.73-35.27) times higher for persons with late initiation of anti-HBV therapy versus early initiation. Patients with late identification of chronic HBV had late or no anti-HBV therapy. Chronic HBV predicted liver failure in patients with solid or hematologic malignancies, whereas male sex and late identification were predictors for patients with solid tumors. CONCLUSIONS: Early identification correlates with early anti-HBV therapy and reduces the risk of liver failure and death in chronic HBVpatients receiving chemotherapy. Cancer 2017;123:3367-76.
Authors: K Rajender Reddy; Kimberly L Beavers; Sarah P Hammond; Joseph K Lim; Yngve T Falck-Ytter Journal: Gastroenterology Date: 2014-10-31 Impact factor: 22.682
Authors: Lindsey Robert Baden; Sankar Swaminathan; Michael Angarone; Gayle Blouin; Bernard C Camins; Corey Casper; Brenda Cooper; Erik R Dubberke; Ashley Morris Engemann; Alison G Freifeld; John N Greene; James I Ito; Daniel R Kaul; Mark E Lustberg; Jose G Montoya; Ken Rolston; Gowri Satyanarayana; Brahm Segal; Susan K Seo; Shmuel Shoham; Randy Taplitz; Jeffrey Topal; John W Wilson; Karin G Hoffmann; Courtney Smith Journal: J Natl Compr Canc Netw Date: 2016-07 Impact factor: 11.908
Authors: Jang-June Park; David K Wong; Abdus S Wahed; William M Lee; Jordan J Feld; Norah Terrault; Mandana Khalili; Richard K Sterling; Kris V Kowdley; Natalie Bzowej; Daryl T Lau; W Ray Kim; Coleman Smith; Robert L Carithers; Keith W Torrey; James W Keith; Danielle L Levine; Daniel Traum; Suzanne Ho; Mary E Valiga; Geoffrey S Johnson; Edward Doo; Anna S F Lok; Kyong-Mi Chang Journal: Gastroenterology Date: 2015-12-10 Impact factor: 22.682
Authors: Sonali Paul; Akriti Saxena; Norma Terrin; Kathleen Viveiros; Ethan M Balk; John B Wong Journal: Ann Intern Med Date: 2015-11-24 Impact factor: 25.391
Authors: Rohit Loomba; Ayana Rowley; Robert Wesley; T Jake Liang; Jay H Hoofnagle; Frank Pucino; Gyorgy Csako Journal: Ann Intern Med Date: 2008-04-01 Impact factor: 25.391
Authors: Jessica P Hwang; Mark R Somerfield; Devena E Alston-Johnson; Donna R Cryer; Jordan J Feld; Barnett S Kramer; Anita L Sabichi; Sandra L Wong; Andrew S Artz Journal: J Clin Oncol Date: 2015-05-11 Impact factor: 44.544
Authors: Jessica P Hwang; Danmeng Huang; John M Vierling; Maria E Suarez-Almazor; Ya-Chen Tina Shih; Mariana Chavez-MacGregor; Zhigang Duan; Sharon H Giordano; Dawn L Hershman; Michael J Fisch; Scott B Cantor Journal: JCO Clin Cancer Inform Date: 2019-03
Authors: Jessica P Hwang; Anna S Lok; Michael J Fisch; Scott B Cantor; Andrea Barbo; Heather Y Lin; Jessica T Foreman; John M Vierling; Harrys A Torres; Bruno P Granwehr; Ethan Miller; Cathy Eng; George R Simon; Sairah Ahmed; Alessandra Ferrajoli; Jorge Romaguera; Maria E Suarez-Almazor Journal: J Clin Oncol Date: 2018-02-15 Impact factor: 50.717