Table 1

HBVr risk groups in patients with cancer according to their anticipating immunosuppressive treatment

Risk groupHBVr rate (%)Hepatitis conditionAnti-HBc
HBsAg statusAnticipating immunosuppressive anticancer treatments
Very high risk>20Chronic infectionAnti-HBc(+)HBsAg(+)Anti-CD20 therapy (ie, rituximab, ofatumumab, obinutuzumab) or hematopoietic SCT.
High risk11–20Chronic infectionAnti-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 risk1–10Chronic infectionAnti-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 infectionAnti-HBc(+)HBsAg(−)Anti-CD20 therapy or hematopoietic SCT.
Low risk<1Chronic infectionAnti-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 infectionAnti-HBc(+)HBsAg(−)High-dose glucocorticoids (eg, ≥20 mg/day) or the anti-CD52 agent, alemtuzumab.
Very low riskRarely occursClinically resolved infectionAnti-HBc(+)HBsAg(−)Cytotoxic chemotherapy without steroids, anti-TNF therapy, methotrexate or azathioprine.
Uncertain riskClinically resolved infectionAnti-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.