Screening, monitoring, prevention, prophylaxis and therapy for Hepatitis B virus reactivation in patients with haematological malignancies and patients who underwent haematological stem cell transplantation: a systematic review

Abstract Background: The growth of new therapeutic options and practices increases the risk of Hepatitis B virus (HBV) reactivation in patients with haematological malignancies and/or patients undergoing haematological stem cell transplantation (HSCT).Objectives: To provide a systematic review supporting recommendations for prevention, monitoring, prophylaxis and therapy of HBV reactivation in patients with haematological malignancies and HSCT. Data sources: The systematic review was based on a search strategy using PubMed and the Cochrane Library from 1991 to December 31, 2016. PRISMA guidelines were followed. Selection criteria: Randomized control trials, prospective and retrospective cohort studies. Risk-of-bias assessment: The risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle Ottawa Scale. Results: 42 studies of fair or good quality were included in this systematic review. The main results obtained are: 1. haematologic patients should be screened for HBV before CHT; 2. HBV DNA levels should be monthly monitored in all HBV-positive patients not receiving prophylaxis; 3. HBsAg-positive haematologic patients and patient underwent HSCT should receive prophylaxis and third-generation HBV drugs should be given 4. anti-HBc-positive lymphoma patients and patients underwent HSCT should receive antiviral prophylaxis. Conclusions: A higher quality of evidence is needed, however the level of evidence was sufficient to support the recommendations published in the same issue of this journal