Comparison of the Occurrence of HBV Reactivation According to the Duration of Preemptive Antiviral Therapy in Chronic Hepatitis B Virus Carriers Receiving Cancer Chemotherapy for Hematologic Diseases
试验速览
- 阶段
- 不适用
- 入组人数
- 126
- 主要终点
- Cumulative incidence rate of hepatitis B viral reactivation
研究概览
简要总结
Previous studies dealt with patients who maintained antiviral drugs for 2 ~ 6 months after final chemotherapy and they revealed that many of the patients who stopped preemptive antiviral drug within 6 months experienced viral reactivation. Based on the study results, guidelines recommend that preemptive antiviral therapy should be maintained for at least 6 months. Nevertheless, many clinicians apply the preemptive antiviral drugs for 1~2 years or longer after final chemotherapy without definite evidences, and this practice increases the medical expenditure a lot. Therefore, the investigators are going to find out the proper and safe duration of preemptive antiviral therapy which can be a good reference in the future practice.
详细描述
HBV reactivation in cancer patients is important not only for directly affecting severe hepatic failure but also for delaying of the further cancer treatments which may cause reduction of overall survival. Thus the guidelines according to the previous studies and other follow-up of randomized studies revealed that patients with positive HbsAg should be administered with preemptive antiviral therapy at least 6 month or more.
However, ideal duration for preemptive antiviral therapy to suppress viral reactivation and withdrawal hepatitis is not clearly identified at present time. It is because previous data just dealt with the efficiency of preemptive antiviral therapy, but most of them did not analyze the outcomes after withdrawal of antiviral therapy. Frequent late-onset reactivation hepatitis in association with preemptive antiviral therapy is mainly due to drug-resistance or post-withdrawal manifestation. Drug-resistance was mainly associated with lamivudine which is now substituted by entecavir or tenofovir which produce lower incidence of resistance (< 1.2% at 6 years). Therefore, the only issue at present is withdrawal hepatitis which may be due to early cessation of the antiviral drug.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •18 years old or older
- •ECOG performance status 0, 1, 2
- •Hodgkin's or Non-Hodgkins lymphomas according to the WHO 2008 classification
- •Patients who received standard cytotoxic chemotherapies
- •Patients who finished chemotherapy (duration not exceeded 6 months) or who will finish the planned chemotherapy
- •Patients who achieved at least partial response and do not need further chemotherapy
- •HBsAg (+) patients who received preemptive antiviral therapies
排除标准
- •Anti-HCV Ab(+), HIV(+), or autoimmune hepatitis
- •Complications due to uncompensated liver cirrhosis
- •Child pugh score : 10 points or more
- •Hepatocellular carcinoma
- •Patients who finish the lymphoma treatments with only radiotherapy
结局指标
主要结局
Cumulative incidence rate of hepatitis B viral reactivation
时间窗: within one year after cessation of the antiviral drug
次要结局
- Severity of reactivation of hepatitis B(within one year after cessation of anviral drugs)
研究者
Jae-Ho, Yoon
Clinical fellowship in Catholic BMT Center
Seoul St. Mary's Hospital