Letter to the Editor
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2024; 30(5): 509-511
Published online Feb 7, 2024. doi: 10.3748/wjg.v30.i5.509
Prevention of hepatitis B reactivation in patients with hematologic malignancies treated with novel systemic therapies: Who and Why?
Matteo Tonnini, Clara Solera Horna, Luca Ielasi
Matteo Tonnini, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
Matteo Tonnini, Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
Clara Solera Horna, Infectious Disease Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia 42123, Italy
Luca Ielasi, Department of Internal Medicine, Ospedale degli Infermi di Faenza, Faenza 48018, Italy
Author contributions: Tonnini M, Solera Horna C and Ielasi L conceived the manuscript; Tonnini M reviewed the literature and wrote the original draft; Tonnini M and Ielasi L reviewed and edited the manuscript; Solera Horna C supervised; and all authors read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Ielasi, MD, Doctor, Department of Internal Medicine, Ospedale degli Infermi di Faenza, Viale Stradone, 9, Faenza 48018, Italy. luca.ielasi.kr@gmail.com
Received: November 1, 2023
Peer-review started: November 1, 2023
First decision: December 7, 2023
Revised: December 15, 2023
Accepted: January 11, 2024
Article in press: January 11, 2024
Published online: February 7, 2024

The risk of reactivation in patients with chronic or past/resolved hepatitis B virus (HBV) infection receiving chemotherapy or immunosuppressive drugs is a well-known possibility. The indication of antiviral prophylaxis with nucleo(t)side analogue is given according to the risk of HBV reactivation of the prescribed therapy. Though the advent of new drugs is occurring in all the field of medicine, in the setting of hematologic malignancies the last few years have been characterized by several drug classes and innovative cellular treatment. As novel therapies, there are few data about the rate of HBV reactivation and the decision of starting or not an antiviral prophylaxis could be challenging. Moreover, patients are often treated with a combination of different drugs, so evaluating the actual role of these new therapies in increasing the risk of HBV reactivation is difficult. First results are now available, but further studies are still needed. Patients with chronic HBV infection [hepatitis B surface antigen (HBsAg) positive] are reasonably all treated. Past/resolved HBV patients (HBsAg negative) are the actual area of uncertainty where it could be difficult choosing between prophylaxis and pre-emptive strategy.

Keywords: Hepatitis B reactivation, Hepatitis B virus, Antiviral prophylaxis, Hematologic malignancies, Chimeric antigens receptor-T cell therapy, Immune checkpoint inhibitors

Core Tip: In the last few years, the advent of several new therapies has characterized the therapeutic scenario of hematologic malignancies. There is now the open issue of assessing the risk of hepatitis B virus reactivation in these patients in order to decide which patients should undergo antiviral prophylaxis.