J Pediatr Infect Dis 2021; 16(02): 062-066
DOI: 10.1055/s-0040-1722282
Original Article

Chemotherapy-Induced Serological Impact in Hepatitis B Surface Antibody Titers in Children with Acute Lymphoblastic Leukemia

1   Department of Family Medicine, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
,
2   Department of Pediatric Hematology Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
,
Ayse C. Oren
2   Department of Pediatric Hematology Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
,
İlkay Dogan
3   Department of Biostatistics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
,
Yasemin Zer
4   Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
› Author Affiliations

Abstract

Objective In our study, we aimed to assess the differences in antibody titers against hepatitis B virus (HBV) prior and post leukemia therapy in children with acute lymphoblastic leukemia (ALL).

Methods Serum hepatitis B surface antibody (anti-HBs) levels of 96 ALL patients were compared before and postcessation of leukemia therapy from patients' medical records.

Results Fifty-five patients were male (57.2%) and 41 patients were female (42.7%), and the mean age was 6.1 years (range, 1 ± 15 years) at the time of diagnosis. Thirty (32.3%) patients were anti-HBs negative, and 66 (68.7%) patients were anti-HBs positive at initial diagnosis. Anti-HBs–positive 66 patients were categorized into two groups, the first group consisted of 28 (42.4%) anti-HBs–negative patients, and the second group consisted of 38 (57.6%) anti-HBs–positive patients after leukemia therapy. On binary logistic regression analysis, lower initial anti-HBs titers were found to be related to anti-HBs negative results post leukemia therapy (relative risk = 3.696, 95% confidence interval: 2.046–6.678; p = 0.001). The area under the curve was 0.849 with 76.1% sensitivity (95% confidence interval: 0.60–0.87; p = 0.001) and 82.6% specificity (95% confidence interval: 0.69–0.91; p = 0.001); the initial anti-HBs titer cut-off value was found 42.9 IU/L.

Conclusion Patients with low-serum anti-HBs titers before leukemia therapy were likely to become anti-HBs negative post leukemia therapy. Therefore, it is necessary to evaluate anti-HBs titers after completing immunosuppressive therapy in patients with ALL.



Publication History

Received: 14 July 2020

Accepted: 29 November 2020

Article published online:
27 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Liaw YF, Chu CM. Hepatitis B virus infection. Lancet 2009; 373 (9663): 582-592
  • 2 Gurol E, Saban C, Oral O, Cigdem A, Armagan A. Trends in hepatitis B and hepatitis C virus among blood donors over 16 years in Turkey. Eur J Epidemiol 2006; 21 (04) 299-305
  • 3 Nilsson A, De Milito A, Engström P. et al. Current chemotherapy protocols for childhood acute lymphoblastic leukemia induce loss of humoral immunity to viral vaccination antigens. Pediatrics 2002; 109 (06) e91
  • 4 Pui CH, Yang JJ, Hunger SP. et al. Childhood acute lymphoblastic leukemia: progress through collaboration. J Clin Oncol 2015; 33 (27) 2938-2948
  • 5 Brodtman DH, Rosenthal DW, Redner A, Lanzkowsky P, Bonagura VR. Immunodeficiency in children with acute lymphoblastic leukemia after completion of modern aggressive chemotherapeutic regimens. J Pediatr 2005; 146 (05) 654-661
  • 6 Alavi S, Rashidi A, Arzanian MT, Shamsian B, Nourbakhsh K. Humoral immunity against hepatitis B, tetanus, and diphtheria following chemotherapy for hematologic malignancies: a report and review of literature. Pediatr Hematol Oncol 2010; 27 (03) 188-194
  • 7 Mustafa MM, Buchanan GR, Winick NJ. et al. Immune recovery in children with malignancy after cessation of chemotherapy. J Pediatr Hematol Oncol 1998; 20 (05) 451-457
  • 8 Zignol M, Peracchi M, Tridello G. et al. Assessment of humoral immunity to poliomyelitis, tetanus, hepatitis B, measles, rubella, and mumps in children after chemotherapy. Cancer 2004; 101 (03) 635-641
  • 9 Choi YB, Lee NH, Yi ES, Kim YJ, Koo HH. Changes in hepatitis B antibody status after chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2019; 66 (12) e27904
  • 10 Wursthorn K, Wedemeyer H, Manns MP. Managing HBV in patients with impaired immunity. Gut 2010; 59 (10) 1430-1445
  • 11 Caver TE, Slobod KS, Flynn PM. et al. Profound abnormality of the B/T lymphocyte ratio during chemotherapy for pediatric acute lymphoblastic leukemia. Leukemia 1998; 12 (04) 619-622
  • 12 Karaman S, Vural S, Yildirmak Y, Urganci N, Usta M. Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer. Ann Saudi Med 2011; 31 (06) 573-576
  • 13 Shin HJ, Lee ES, Han SB. et al. Serological changes against hepatitis b surface antigen in children and adolescents receiving chemotherapy for acute leukemia. Mediterr J Hematol Infect Dis 2019; 11 (01) e2019052
  • 14 Yilmaz B, Erdem D, Teker F. et al. The effect of anticancer therapy on anti-hepatitis B antibody titres in patients with haematological malignancies and solid tumours. J Int Med Res 2016; 44 (03) 627-638