BCR/ABL tyrosine kinase inhibitors (TKI) is now a standard initial treatment for chronic myeloid leukemia (CML). Several cases reported that hepatitis B virus (HBV) reactivation were related to imatinib therapy. However, it is still unclear whether imatinib or other TKIs induce HBV reactivation in hepatitis B surface antigen (HBsAg)-positive patients. The aim of this study is to investigate the incidence of HBV reactivation and analyze risk factors associated with HBV reactivation in CML patients who are treated with various TKIs.
We retrospectively reviewed the medical records from 8 centers in South Korea. HBsAg-positive CML patients under imatinib or other TKIs treatment were analyzed.
702 patients were diagnosed CML from participating centers. HBsAg-positive rate was 6.1% (43/702) at diagnosis. In the 43 HBsAg-positive patients, nine patients received prophylactic therapy and HBV reactivation rate was 34.9% (15/43) (95% CI: 21.0–50.9%). Patients who received prophylaxis did not develop HBV reactivation. The median age and the male to female ratio of the HBV reactivated patients were 47.0 years (range; 22–63) and 4:1, respectively. HBV reactivation according to each TKI treatments were: 12 cases under imatinib, 2 cases under dasatinib, and 1 case under nilotinib. Median time to HBV reactivation was 9.3 months (range; 2.3–68.8 months) (95% CI: 5.9 – 28.5 months). None of the patients died due to HBV reactivation, but one patient received liver transplantation due to hepatic failure. Prophylactic therapy and HBV DNA level at diagnosis were the factors associated with HBV reactivation (P=0.011 and P=0.036, respectively).
This is first report that has analyzed HBV reactivation in HBsAg-positive CML patients during TKIs treatment. Prophylaxis should be considered to prevent HBV reactivation during TKI treatment. Also, we recommend that HBsAg-positive patients with CML receiving TKI treatment be closely monitored.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.