December 9, 2019
Scientists with Taiwan’s National Health Research Institutes (NHRI) and National Taiwan University Hospital, with the support of the Taiwan Cooperative Oncology Group (TCOG), have determined that prophylactic antiviral therapy for lymphoma patients will be essential to optimizing preventative strategies and the allocation of medical resources.
In hepatitis B virus (HBV)-endemic areas, prophylactic antiviral therapy is recommended for HBV surface antigen (HBsAg)-positive lymphoma patients who receive rituximab-containing regimens to reduce HBV-related complications (fulminant hepatitis or hepatic failure).
HBV reactivation may occur in 10% to 30% of patients with lymphoma and resolved HBV infection who undergo rituximab-containing chemotherapy. Liver decompensation due to chemotherapy-induced HBV reactivation can be life-threatening. In HBV-endemic areas, approximately 60% of the adult population has resolved HBV infections.
Currently, patients may undergo regular blood chemistry follow-up during chemotherapy without prophylactic anti-viral therapy or regular HBV DNA monitoring. Patients with documented HBV-related hepatitis flare were treated by antiviral therapy. However, international clinical practice guidelines advise prophylactic antiviral therapy for lymphoma patients who receive rituximab-containing regimens. Alternatively, the patients can be followed up regularly by monitoring HBV DNA and alanine aminotransferase levels every one to three months and start antiviral therapy upon HBV reactivation.
Using the results of studies conducted throughout Taiwan over the past ten years by the Taiwan Cooperative Oncology Group (TCOG), teams of scientists in Taiwan determined the cost effectiveness of the two above options for the prevention of HBV-related complications. The teams comprised groups led by Dr. Chao A. Hsiung, the director of the NHRI’s Institute of Population Health Sciences; Dr. Chin-Fu Hsiao, the institute’s deputy director; Dr. Hsiao-Hui Tsou; Dr. Tsang-Wu Liu, deputy director of the National Institute of Cancer Research; Dr. Chiun Hsu, of the National Taiwan University College of Medicine; and Dr. Pei-Jer Chen, Dr. Ann-Lii Cheng, and Dr. Hung-Chih Yang.
The present study demonstrated that prophylactic anti-viral therapy is more cost-effective in most settings, and that identification of high-risk subgroups that are most vulnerable to HBV-related complications may improve the cost-effectiveness of prophylactic antiviral therapy and resource allocation in HBV-endemic areas.
The findings of the study were published earlier this year in the Journal of the Formosan Medical Association.
For the full text of the publication, visit https://doi.org/10.1016/j.jfma.2019.05.027