Passive transfer of anti-HBc after intravenous immunoglobulin administration in patients with cancer: a retrospective chart review
The Lancet Haematology, 2018•thelancet.com
Background Patients previously infected with hepatitis B virus (HBV; indicated by positivity
for anti-HBc) can experience HBV reactivation during cancer chemotherapy. Intravenous
immunoglobulin infusion, which is frequently used in supportive care, might facilitate passive
transfer of anti-HBc. We aimed to estimate the probability of passive transfer of anti-HBc after
intravenous immunoglobulin infusion in patients with cancer. Methods We reviewed
institutional databases to identify adult patients who received outpatient chemotherapy …
for anti-HBc) can experience HBV reactivation during cancer chemotherapy. Intravenous
immunoglobulin infusion, which is frequently used in supportive care, might facilitate passive
transfer of anti-HBc. We aimed to estimate the probability of passive transfer of anti-HBc after
intravenous immunoglobulin infusion in patients with cancer. Methods We reviewed
institutional databases to identify adult patients who received outpatient chemotherapy …
Background
Patients previously infected with hepatitis B virus (HBV; indicated by positivity for anti-HBc) can experience HBV reactivation during cancer chemotherapy. Intravenous immunoglobulin infusion, which is frequently used in supportive care, might facilitate passive transfer of anti-HBc. We aimed to estimate the probability of passive transfer of anti-HBc after intravenous immunoglobulin infusion in patients with cancer.
Methods
We reviewed institutional databases to identify adult patients who received outpatient chemotherapy between Jan 1, 2004, and Dec 31, 2011, at the University of Texas MD Anderson Cancer Center, Houston, TX, USA. Eligible patients had received intravenous immunoglobulin therapy, had tested negative for both anti-HBc and HBsAg before infusion, and had been tested for anti-HBc after infusion. The primary endpoint was the proportion of patients who became positive for anti-HBc after intravenous immunoglobulin infusion.
Findings
950 of 18 874 patients who underwent chemotherapy within the study time frame received intravenous immunoglobulin, of whom 870 had been tested for anti-HBc before infusion. 199 patients who were negative for anti-HBc before receiving intravenous immunoglobulin were retested after infusion, of whom 29 (15% [95% CI 10–20]) became positive for anti-HBc. The probability of anti-HBc conversion at 1 week after intravenous immunoglobulin infusion was 34% (95% CI 22–48) and at 12 weeks was 4% (2–7).
Interpretation
Conversion of patients from anti-HBc negativity to anti-HBc positivity was common after intravenous immunoglobulin administration. However, the probability of a positive test decreased with time since infusion. Positive anti-HBc tests done shortly after intravenous immunoglobulin infusion should be interpreted with caution because they might indicate passive transfer instead of true infection.
Funding
None.
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