Recommendations for screening, diagnosis, prophylaxis and treatment of hepatitis in haemato-oncological patients - CELL recommendations
Abstrakt
Viral hepatitis affects millions of people worldwide, with host immunity deciding on the outcome of infection. In patients with haematological malignancies or recipients of haematopoietic stem cells the virus may cause life-threatening complications either due to the virus itself or to the need to interrupt or reduce the chemotherapy.
The infected haematopoietic stem cell donor can also transmit viral hepatitis. Knowing complete HBV (hepatitis B virus) serostatus is essential for the right choice of treatment, prophylaxis or pre-emptive approach.
Recent recommendations favour treatment using molecules with a high barrier to resistance. In HCV infection, administration of new, direct-acting antiviral agents (DAA), is safe in haematological patients.
The use of DAAs in first line is recommended, either as a single treatment for indolent lymphomas or in combination with chemotherapy for aggressive lymphomas. Due to the existing risk of chronic hepatitis E in immunocompromised patients, marker screening should be performed if there are signs and symptoms of hepatitis.
In the case of HEV infection, reduction in immunosuppression is recommended and if not possible or unsuccessful, treatment with ribavirin may be considered. Hepatitis A does not progress to chronicity but may be more severe in elderly and immunocompromised patients with risk of hepatic failure.
The CELL (Czech Leukaemia Study Group - for Life) Working Group for the Treatment of Opportunistic Infections recommends that all patients undergo screening for hepatotropic viruses before haematological treatment and that patients or donors of haematopoietic stem cells with markers of previous or current viral hepatitis should be consulted with specialists (infectious disease specialist/hepatologists). The screening, vaccination and treatment guidelines outlined here were presented and discussed at the CELL workshop in Brno in May 2018.