A patient with chronic hepatitis B is at risk for disease reactivation and fulminant hepatitis if treated for cancer. The mortality rate in these patients if untreated is high.
Risk factors for reactivation of hepatitis B:
(1) presence of hepatitis B DNA or hepatitis B surface antigen (HBsAg) in the blood prior to chemotherapy
(2) therapy with corticosteroids
(3) therapy with rituximab or other drugs targeting B-cells
(4) stem cell or bone marrow transplantation
(5) breast cancer or malignant lymphoma
Patients should be screened for hepatitis B prior to starting cancer therapy.
Hepatitis B Virus DNA and/or HBsAg
Antibodies to Hepatitis B Core Antigen
Treatment
positive
NA
lamuvidine or alternative drug during chemotherapy and for 6 months afterwards
negative
positive
monitor blood ALT and HBV DNA levels; treat with lamuvidine if rising
negative
negative
vaccinate against HBV
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