Contributions
Abstract: PB2025
Type: Publication Only
Background
Immunochemotherapy is an important treatment modality in haematological malignancies and hepatitis B virus (HBV) reactivation is known to occur following this. Although it is more commonly seen in patients with positive hepatitis B surface antigen (HBsAg), it can also occur in patients who are negative HBsAg but have detectable anti-HBV core antibody (anti-HBcAb), indicating past ‘resolved’ infection. Hence, patients should be screened for both HBsAg and anti-HBcAb prior to commencing immunochemotherapy that are known to increase risk for HBV reactivation. Patients with positive anti-HBcAb can often still be treated with immunochemotherapy but require antiviral prophylaxis, joint-care with a gastroenterologist and close monitoring of viral blood tests. An audit was initially conducted to assess the rates of HBV screening among patients being commenced on rituximab-containing regimens in the haematology department at Royal Surrey County Hospital (RSCH). This audit demonstrated that significant numbers of patients were not being screened fully and remedial measures were put in place. Following that, a re-audit was conducted to assess compliance rates post-intervention. Some studies have also shown HBV reactivation during treatments with ibrutinib, lenalidomide and obinituzumab, therefore we have included this cohort of patients in the re-audit. This re-audit showed that haemato-oncologists' practice on appropriate HBV screening can be improved to minimise risk of HBV reactivation.
Aims
To assess compliance with full HBV screening (HBsAg and anti-HBcAb) in patients receiving rituximab, ibrutinib, lenalidomide or obinutuzumab containing regimens at Royal Surrey County Hospital following remedial measures after the previous audit.
Methods
Patients who had been commenced on regimens including rituximab, ibrutinib, lenalidomide or obinutuzumab under the haemato-oncology unit were identified from the ARIA chemotherapy e-prescribing system. This included patients on regimens commencing 01/01/2017 to 24/11/2017. Winpath system was used to check for HBV testing over the last 10 years.
Results
64 patients were identified; of which 54 patients on rituximab-containing regimens, 6 on ibrutinib, 3 on lenalidomide and 1 on obinutuzumab. This re-audit has clearly shown that there has been an improvement in rates of full HBV testing prior to treatment with immunochemotherapy. This was evidenced by an improvement from 7% to 56%. However, there were still a quarter of patients who did not have any HBV testing at all (only showing a modest improvement from 29% to 25%).
Conclusion
This result has clearly shown that there is a need to assess haemato-oncologists' practice in ensuring a full HBV testing is done prior to commencing immunochemotherapy agents which are recognised as risks for HBV reactivation. Appropriate remedial measures have shown to improve compliance rates. In our cohort, of all the patients who had a complete screening of both HBsAg and anti-HBcAb, 2 were found to be positive anti-HBcAb and received appropriate viral prophylaxis and regular HBV DNA viral load monitoring. This highlighted the importance of a proper screening prior to subjecting the patients to reactivation risks. In conclusion, a significant improvement in HBV testing rates has been achieved. However, ongoing efforts are required to bring about further improvement to ensure patient risks are minimised.
Session topic: 20. Indolent Non-Hodgkin lymphoma – Clinical
Keyword(s): chemotherapy, Hepatitis B virus, Immunotherapy, Lymphoma therapy
Abstract: PB2025
Type: Publication Only
Background
Immunochemotherapy is an important treatment modality in haematological malignancies and hepatitis B virus (HBV) reactivation is known to occur following this. Although it is more commonly seen in patients with positive hepatitis B surface antigen (HBsAg), it can also occur in patients who are negative HBsAg but have detectable anti-HBV core antibody (anti-HBcAb), indicating past ‘resolved’ infection. Hence, patients should be screened for both HBsAg and anti-HBcAb prior to commencing immunochemotherapy that are known to increase risk for HBV reactivation. Patients with positive anti-HBcAb can often still be treated with immunochemotherapy but require antiviral prophylaxis, joint-care with a gastroenterologist and close monitoring of viral blood tests. An audit was initially conducted to assess the rates of HBV screening among patients being commenced on rituximab-containing regimens in the haematology department at Royal Surrey County Hospital (RSCH). This audit demonstrated that significant numbers of patients were not being screened fully and remedial measures were put in place. Following that, a re-audit was conducted to assess compliance rates post-intervention. Some studies have also shown HBV reactivation during treatments with ibrutinib, lenalidomide and obinituzumab, therefore we have included this cohort of patients in the re-audit. This re-audit showed that haemato-oncologists' practice on appropriate HBV screening can be improved to minimise risk of HBV reactivation.
Aims
To assess compliance with full HBV screening (HBsAg and anti-HBcAb) in patients receiving rituximab, ibrutinib, lenalidomide or obinutuzumab containing regimens at Royal Surrey County Hospital following remedial measures after the previous audit.
Methods
Patients who had been commenced on regimens including rituximab, ibrutinib, lenalidomide or obinutuzumab under the haemato-oncology unit were identified from the ARIA chemotherapy e-prescribing system. This included patients on regimens commencing 01/01/2017 to 24/11/2017. Winpath system was used to check for HBV testing over the last 10 years.
Results
64 patients were identified; of which 54 patients on rituximab-containing regimens, 6 on ibrutinib, 3 on lenalidomide and 1 on obinutuzumab. This re-audit has clearly shown that there has been an improvement in rates of full HBV testing prior to treatment with immunochemotherapy. This was evidenced by an improvement from 7% to 56%. However, there were still a quarter of patients who did not have any HBV testing at all (only showing a modest improvement from 29% to 25%).
Conclusion
This result has clearly shown that there is a need to assess haemato-oncologists' practice in ensuring a full HBV testing is done prior to commencing immunochemotherapy agents which are recognised as risks for HBV reactivation. Appropriate remedial measures have shown to improve compliance rates. In our cohort, of all the patients who had a complete screening of both HBsAg and anti-HBcAb, 2 were found to be positive anti-HBcAb and received appropriate viral prophylaxis and regular HBV DNA viral load monitoring. This highlighted the importance of a proper screening prior to subjecting the patients to reactivation risks. In conclusion, a significant improvement in HBV testing rates has been achieved. However, ongoing efforts are required to bring about further improvement to ensure patient risks are minimised.
Session topic: 20. Indolent Non-Hodgkin lymphoma – Clinical
Keyword(s): chemotherapy, Hepatitis B virus, Immunotherapy, Lymphoma therapy