No evidence of HBV
infection
a
Anti-CD20
therapy or stem
cell transplant
All other systemic
anticancer therapy
c
(cytotoxic,
immunotherapy, or
targeted therapy)
Start antiviral prophylaxis,
continue at least 12 mos
after last anticancer
therapy.
d
Monitoring
• Check HBV DNA and ALT at baseline
and every 6 mos during antiviral
therapy.
• After anticancer therapy, monitor
ALT for hepatitis flares,
e
after
stopping antiviral therapy.
• Check HBsAg and ALT every 3
mos during anticancer therapy.
• If HBsAg+, then start antiviral
therapy immediately.
• If hepatitis flare,
e
check HBV
DNA. If HBV DNA >1000 IU/mL,
start antiviral therapy
immediately.
PAST HBV
b
HBsAg–
anti-HBc+
c
All other systemic anticancer therapy besides anti-CD20 therapy or stem cell transplantation. Due to
the lack of strong data, the risk of HBV reactivation is unclear for specific anticancer drugs besides anti-
CD20 therapy or stem cell transplantation. It is possible that these anticancer therapies have a low risk of
reactivation for patients with past HBV infection and may not require routine monitoring.
d
An alternative pathway is careful monitoring with HBsAg and HBV DNA every 3 months with
immediate antiviral therapy at the earliest sign of HBV reactivation so long as patients and providers are
able to adhere to frequent and consistent follow up during and for up to 12 months aer last anti-cancer
therapy (see text for details).
e
Hepatitis flare: ALT >100 U/mL and 3 times baseline.
f
Long-term antiviral therapy management for patients with cancer aer the cessation of anticancer
therapy should follow national hepatolog y recommendations for all patients with chronic HBV.
