HBVr risk groups in patients with cancer according to their anticipating immunosuppressive treatment
| Risk group | HBVr rate (%) | Hepatitis condition | Anti-HBc Status | HBsAg status | Anticipating immunosuppressive anticancer treatments |
| Very high risk | >20 | Chronic infection | Anti-HBc(+) | HBsAg(+) | Anti-CD20 therapy (ie, rituximab, ofatumumab, obinutuzumab) or hematopoietic SCT. |
| High risk | 11–20 | Chronic infection | Anti-HBc(+) | HBsAg(+) | High-dose steroids (ie, ≥20 mg/day for at least 4 weeks); anthracycline derivatives such as doxorubicin and epirubicin; or the anti-CD52 agent, alemtuzumab. |
| Moderate risk | 1–10 | Chronic infection | Anti-HBc(+) | HBsAg(+) | Cytotoxic chemotherapy without steroids; anti-TNF therapy; cytokine and integrin inhibitors, tyrosine kinase inhibitors, or anti-rejection therapy for solid organ transplants. |
| Clinically resolved infection | Anti-HBc(+) | HBsAg(−) | Anti-CD20 therapy or hematopoietic SCT. | ||
| Low risk | <1 | Chronic infection | Anti-HBc(+) | HBsAg(+) | Methotrexate or azathioprine and any dose of steroids lasting less than a week or low-dose (eg, <10 mg prednisone daily) lasting greater than or equal to 4 weeks. |
| Clinically resolved infection | Anti-HBc(+) | HBsAg(−) | High-dose glucocorticoids (eg, ≥20 mg/day) or the anti-CD52 agent, alemtuzumab. | ||
| Very low risk | Rarely occurs | Clinically resolved infection | Anti-HBc(+) | HBsAg(−) | Cytotoxic chemotherapy without steroids, anti-TNF therapy, methotrexate or azathioprine. |
| Uncertain risk | Clinically resolved infection | Anti-HBc(+) | HBsAg(−) | Solid organ transplant influenced by the type and the degree of used immunosuppressive therapy. |
anti-HBc, anti-hepatitis B core antibody; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; HBVr, HBV reactivation; SCT, stem cell transplantation; TNF, tumor necrosis factor.