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Sa1019 Incidence of Hepatitis B Surface Antigen and Hepatitis B Core Antibody in a Screening Population Undergoing Chemotherapy
patients prior to treatment leads to appropriate prophylaxis against HBV reactivation. Prospective studies are needed to identify the optimal timing, duration and type of such prophylaxis with a goal of zero percent reactivation.
Sa1020 Hepatitis B Virus Infection and Risk of Non-Hodgkin Lymphoma: A MetaAnalysis of Case-Control Studies Rajan Kanth, Anupama Inaganti, Naga Swetha Samji, Sarah D. Komanapalli, Brian B. Borg, Praveen K. Roy
AASLD Abstracts
Purpose: Several studies have suggested association between hepatitis C virus (HCV) and non-hodgkin lymphoma (NHL). But the role of hepatitis B virus (HBV) in the pathogenesis of lymphoproliferative malignancy is not clear. We performed a meta-analysis of case-control studies to evaluate the role of HBV infection in NHL. Method: Pubmed, Embase, Web of knowledge, reference lists of retrieved articles and conference abstracts were searched for relevant studies (Search date Oct-2012). Case control studies were included. Studies related to HBV reactivation after chemotherapy and cohort studies were excluded. Standardized forms were used to extract data. Data was extracted by two reviewers independently. Odds ratio was calculated using comprehensive Meta-analysis software. Heterogeneity and publication bias were also assessed. Random effects model was used for pooling the data. Result: Nineteen studies were included (cases 13947/controls 1559448). Studies were reported from Europe (8), South Korea (4), Japan (1), Taiwan (1), Singapore (1), China (1), Pakistan (1), Egypt (1) and Saudi-Arabia (1). Hepatitis B was diagnosed by detection of HBsAg (17 studies) and by self-report history (2 studies). NHL was diagnosed by histopathology. Controls were non-lymphoma cancer/hospital patients (9 studies), healthy population (8 studies) and both (2 studies). 1205 cases of HBV infection were found in the NHL cases group and 40592 HBV infection were present in the control group. HBV infection was higher in patients with NHL compared to the controls (OR 2.53; 95% CI, 2.10-3.03, p ,0.001). Subgroup analysis showed higher risk of HBV infection in NHL in both developing countries (Asia) and developed countries (Europe). No difference was noted between hospitals based controls and population based controls. Significant heterogeneity was not present among the studies. Conclusion: The present meta-analysis based on 19 studies suggests hepatitis B virus infection as a risk factor for NHL. Further cohort studies are needed to prove this association. Sa1021 Real-Time Tissue Elastography for the Assessment of Liver Fibrosis in Patients With Chronic Hepatitis C and Correlation With Response to PegylatedInterferon-Alpha 2B and Ribavirin Combination Therapy Kazuhiko Hayashi, Yoshiaki Katano, Yoji Ishizu, Teiji Kuzuya, Takashi Honda, Masatoshi Ishigami, Hidemi Goto OBJECTIVES: Percutaneous liver biopsy is considered the gold standard for evaluating the stage of liver fibrosis, but has been pointed out the limitations. Therefore, many non-invasive methods for the assessment of liver fibrosis have been developed to replace liver biopsy. Liver stiffness measured by transient elastography has been reported the utility for assessment of liver fibrosis. Real-time tissue elastography (RTE) is a kind of transient elastography which could measure liver stiffness. However, the assessments of liver fibrosis by RTE are not well known. The primary aim of the present study was to determine whether RTE is useful in diagnosing liver fibrosis in patients with chronic hepatitis C. Several studies suggested that liver fibrosis might have impact on the response to interferon therapy. A secondary aim was to investigate the association between liver stiffness by RTE and response to pegylatedinterferon-alpha 2b and ribavirin combination therapy. (Methods) One hundred eleven patients with chronic hepatitis C were enrolled for this study. The patients consisted of 51 men and 60 women with a mean age of 54.2 (range, 19 to 78) years. Liver biopsy was performed and fibrosis stage was diagnosed according to the METAVIR criteria. Fifty patients received pegylated-IFN-alpha 2b once each week plus oral ribavirin daily for 48 or 72 weeks. Detection of the SNP of IL28B (rs8099917) was done by a real-time PCR system with specific probes. RESULTS: The fibrosis stage was diagnosed as F0 (n = 30), F1 (n = 40), F2 (n = 21), F3 (n = 13), and F4 (n = 17) by liver biopsy. Receiver Operatorating Characteristic (ROC) curve analysis was performed for fibrosis stage by RTE. Area Under the Curve (AUC) for F1,, F2,, F3,, and F4, were 0.761, 0.791, 0.819, and 0.7917 respectively (p ,0.05). The cut-off value of F3, was defined by ROC curve and divided into 2 groups (mild fibrosis and severe fibrosis). Of the 50 patients, 16 achieved sustained virologic response (SVR). SVR was achieved in 9% of patients with severe fibrosis by RTE and 38.5% of patients with mild fibrosis. Achievement of SVR occurred more frequently in patients with TT allele (37.5%) than in those with TG and GG alleles (22.2%). The best SVR rate was achieved in patients with mild fibrosis by RTE and T allele, and the worst response was achieved in patients with severe fibrosis by RTE and G allele. CONCLUSIONS: RTE could evaluate the degree of liver fibrosis. Combining RTE and IL28B could improve the predictive value of SVR in patients with chronic hepatitis C.
Sa1019 Incidence of Hepatitis B Surface Antigen and Hepatitis B Core Antibody in a Screening Population Undergoing Chemotherapy Mary K. Sammons, Robin B. Mendelsohn, Kent Sepkowitz, Dhruv Patel, Eric J. Sherman, Andrew D. Zelenetz, Emmy Ludwig Background: Reactivation of hepatitis B virus (HBV) infection is a well-recognized complication after immunosuppression from chemotherapeutic agents and can lead to significant morbidity and mortality. We previously reported 23 HBV reactivations in patients of diverse nationalities without association with a particular malignancy or medication. Our institution subsequently initiated a protocol in which all new patients receiving immunosuppressive therapy are screened for HBV and offered anti-viral prophylaxis. The aim of this study is to report the prevalence of HBV surface antigen (HBsAg) and HBV core antibody (HBcAb) positivity since the inception of this screening program. Methods: We conducted a prospective study of all patients at Memorial Sloan-Kettering Cancer Center who were started on immunosuppressive therapy and screened for HBV from May 2009 to November 1, 2012. Patients were screened using tests for HBsAg and HBcAb. If either of these were positive, PCR for HBV DNA was reflexively measured. Patient demographics --including type of malignancy-were recorded. Results: Between May 1 2009 and November 1 2012, 17183 patients met criteria for screening and 12,328 patients (median age 64 years [24-95], 54.4% male) were screened for HBV prior to initiation of immunosuppression (71.75% compliance). Testing revealed 78(0.6%) patients positive for both HbsAg and HbcAb (median age 58, 69.2% male).Of this group, 47/78 (60.26%) had detectable HBV DNA PCR (955766.7 mean, 521 median) .Primary diagnoses of these patients included lymphoma 6.4%, leukemia 2.6%, and myriad solid tumors 91.0%. In addition, 994 patients (8.1%) were negative for HBsAg and positive for HBcAb (median age 58, 53.2% male), Diagnoses among this group included 6.0% lymphoma, 2.0% leukemia and 92.0 % solid tumor. Of this group, 7 (0.7%) had detectable HBV DNA PCR ([41-1,740,000 IU/mL]). Conclusion: In our population screened for HBV prior to initiation of immunosuppression, we report a prevalence of 0.6% for HBsAg positive patients and 8.1% for HBsAg negative, HBcAb positive patients. Screening of these
AASLD Abstracts
S-974
Sa1020 Hepatitis B Virus Infection and Risk of Non-Hodgkin Lymphoma: A MetaAnalysis of Case-Control Studies Rajan Kanth, Anupama Inaganti, Naga Swetha Samji, Sarah D. Komanapalli, Brian B. Borg, Praveen K. Roy
AASLD Abstracts
Purpose: Several studies have suggested association between hepatitis C virus (HCV) and non-hodgkin lymphoma (NHL). But the role of hepatitis B virus (HBV) in the pathogenesis of lymphoproliferative malignancy is not clear. We performed a meta-analysis of case-control studies to evaluate the role of HBV infection in NHL. Method: Pubmed, Embase, Web of knowledge, reference lists of retrieved articles and conference abstracts were searched for relevant studies (Search date Oct-2012). Case control studies were included. Studies related to HBV reactivation after chemotherapy and cohort studies were excluded. Standardized forms were used to extract data. Data was extracted by two reviewers independently. Odds ratio was calculated using comprehensive Meta-analysis software. Heterogeneity and publication bias were also assessed. Random effects model was used for pooling the data. Result: Nineteen studies were included (cases 13947/controls 1559448). Studies were reported from Europe (8), South Korea (4), Japan (1), Taiwan (1), Singapore (1), China (1), Pakistan (1), Egypt (1) and Saudi-Arabia (1). Hepatitis B was diagnosed by detection of HBsAg (17 studies) and by self-report history (2 studies). NHL was diagnosed by histopathology. Controls were non-lymphoma cancer/hospital patients (9 studies), healthy population (8 studies) and both (2 studies). 1205 cases of HBV infection were found in the NHL cases group and 40592 HBV infection were present in the control group. HBV infection was higher in patients with NHL compared to the controls (OR 2.53; 95% CI, 2.10-3.03, p ,0.001). Subgroup analysis showed higher risk of HBV infection in NHL in both developing countries (Asia) and developed countries (Europe). No difference was noted between hospitals based controls and population based controls. Significant heterogeneity was not present among the studies. Conclusion: The present meta-analysis based on 19 studies suggests hepatitis B virus infection as a risk factor for NHL. Further cohort studies are needed to prove this association. Sa1021 Real-Time Tissue Elastography for the Assessment of Liver Fibrosis in Patients With Chronic Hepatitis C and Correlation With Response to PegylatedInterferon-Alpha 2B and Ribavirin Combination Therapy Kazuhiko Hayashi, Yoshiaki Katano, Yoji Ishizu, Teiji Kuzuya, Takashi Honda, Masatoshi Ishigami, Hidemi Goto OBJECTIVES: Percutaneous liver biopsy is considered the gold standard for evaluating the stage of liver fibrosis, but has been pointed out the limitations. Therefore, many non-invasive methods for the assessment of liver fibrosis have been developed to replace liver biopsy. Liver stiffness measured by transient elastography has been reported the utility for assessment of liver fibrosis. Real-time tissue elastography (RTE) is a kind of transient elastography which could measure liver stiffness. However, the assessments of liver fibrosis by RTE are not well known. The primary aim of the present study was to determine whether RTE is useful in diagnosing liver fibrosis in patients with chronic hepatitis C. Several studies suggested that liver fibrosis might have impact on the response to interferon therapy. A secondary aim was to investigate the association between liver stiffness by RTE and response to pegylatedinterferon-alpha 2b and ribavirin combination therapy. (Methods) One hundred eleven patients with chronic hepatitis C were enrolled for this study. The patients consisted of 51 men and 60 women with a mean age of 54.2 (range, 19 to 78) years. Liver biopsy was performed and fibrosis stage was diagnosed according to the METAVIR criteria. Fifty patients received pegylated-IFN-alpha 2b once each week plus oral ribavirin daily for 48 or 72 weeks. Detection of the SNP of IL28B (rs8099917) was done by a real-time PCR system with specific probes. RESULTS: The fibrosis stage was diagnosed as F0 (n = 30), F1 (n = 40), F2 (n = 21), F3 (n = 13), and F4 (n = 17) by liver biopsy. Receiver Operatorating Characteristic (ROC) curve analysis was performed for fibrosis stage by RTE. Area Under the Curve (AUC) for F1,, F2,, F3,, and F4, were 0.761, 0.791, 0.819, and 0.7917 respectively (p ,0.05). The cut-off value of F3, was defined by ROC curve and divided into 2 groups (mild fibrosis and severe fibrosis). Of the 50 patients, 16 achieved sustained virologic response (SVR). SVR was achieved in 9% of patients with severe fibrosis by RTE and 38.5% of patients with mild fibrosis. Achievement of SVR occurred more frequently in patients with TT allele (37.5%) than in those with TG and GG alleles (22.2%). The best SVR rate was achieved in patients with mild fibrosis by RTE and T allele, and the worst response was achieved in patients with severe fibrosis by RTE and G allele. CONCLUSIONS: RTE could evaluate the degree of liver fibrosis. Combining RTE and IL28B could improve the predictive value of SVR in patients with chronic hepatitis C.
Sa1019 Incidence of Hepatitis B Surface Antigen and Hepatitis B Core Antibody in a Screening Population Undergoing Chemotherapy Mary K. Sammons, Robin B. Mendelsohn, Kent Sepkowitz, Dhruv Patel, Eric J. Sherman, Andrew D. Zelenetz, Emmy Ludwig Background: Reactivation of hepatitis B virus (HBV) infection is a well-recognized complication after immunosuppression from chemotherapeutic agents and can lead to significant morbidity and mortality. We previously reported 23 HBV reactivations in patients of diverse nationalities without association with a particular malignancy or medication. Our institution subsequently initiated a protocol in which all new patients receiving immunosuppressive therapy are screened for HBV and offered anti-viral prophylaxis. The aim of this study is to report the prevalence of HBV surface antigen (HBsAg) and HBV core antibody (HBcAb) positivity since the inception of this screening program. Methods: We conducted a prospective study of all patients at Memorial Sloan-Kettering Cancer Center who were started on immunosuppressive therapy and screened for HBV from May 2009 to November 1, 2012. Patients were screened using tests for HBsAg and HBcAb. If either of these were positive, PCR for HBV DNA was reflexively measured. Patient demographics --including type of malignancy-were recorded. Results: Between May 1 2009 and November 1 2012, 17183 patients met criteria for screening and 12,328 patients (median age 64 years [24-95], 54.4% male) were screened for HBV prior to initiation of immunosuppression (71.75% compliance). Testing revealed 78(0.6%) patients positive for both HbsAg and HbcAb (median age 58, 69.2% male).Of this group, 47/78 (60.26%) had detectable HBV DNA PCR (955766.7 mean, 521 median) .Primary diagnoses of these patients included lymphoma 6.4%, leukemia 2.6%, and myriad solid tumors 91.0%. In addition, 994 patients (8.1%) were negative for HBsAg and positive for HBcAb (median age 58, 53.2% male), Diagnoses among this group included 6.0% lymphoma, 2.0% leukemia and 92.0 % solid tumor. Of this group, 7 (0.7%) had detectable HBV DNA PCR ([41-1,740,000 IU/mL]). Conclusion: In our population screened for HBV prior to initiation of immunosuppression, we report a prevalence of 0.6% for HBsAg positive patients and 8.1% for HBsAg negative, HBcAb positive patients. Screening of these
AASLD Abstracts
S-974