Investigation of pre- and post-treatment changes of hepatitis markers in patients with hematological malignancies receiving immunosuppressive treatment

Objectives: It is known that immunosuppressive treatments used in cancer and some other diseases may cause exacerbations of hepatitis and this may adversely affect the prognosis. The relationship between changes in hepatitis markers and the degree of immunosuppression, drugs used, and underlying diseases is increasingly being studied. In this study, it was aimed to investigate the frequency of changes in hepatitis markers, the time of occurrence, and the relationship with diagnosis and treatment in patients with hematological malignancies receiving immunosuppressive therapy. Material and Method: In the MCBU Hematology Department, 345 newly diagnosed patients aged 18 years and older with hematological malignancies between 2018 and 2020 were evaluated retrospectively. Age, gender, diagnosis, treatment protocols, hepatitis markers of 119 patients with pretreatment and post-treatment data were analyzed. Chemotherapy protocols were classified according to steroid and rituximab use. Data were obtained from the hospital information record system. Statistical evaluation was made with the SPSS 21.0 program. Results: In our patient group, HBsAg (+) 3.2%, Anti-HBc Ig G (+) 26.4%, Anti-HBs (+) 36.7% were detected before treatment. In 1 (0.9%) of 113 patients who had HBsAg (-) before treatment, HBsAg (+) after treatment, Anti-HBs (-) after treatment in 6 (14.6%) of 41 patients with anti-HBs (+), Anti-HBc IgG (+) was found in 5 (6.1%) of 82 patients who were found to have Anti-HBc IgG (-). Anti-HBs was positive in 18 (27.3%) of 66 vaccinated patients. The rate of change in any parameter of 119 patients in terms of HBV was 31.9% (38/119). Antibody gain was observed in 24 of 38 patients, while antibody loss was observed in 12. Conclusion: Pre-treatment hepatitis data were found to be similar to the data of our country. The rate of immunization with hepatitis B vaccine is low. Changes in hepatitis markers in approximately one third of the patients were not related to gender, age and treatment, but were associated with the diagnosis (p<0.01). This change is mostly seen in patients with AML, followed by MM. Antibody loss may occur under treatment, hepatitis markers may change at any time, including vaccinated patients, and continued serological follow-up may be important in terms of both revaccination and prophylaxis needs. In this respect, it is thought that studies in which more cases are followed for a longer period of time can shed light on the subject. Keywords: Hematological malignancy, Immunsuppresive treatment, Hepatitis reactivation, Hepatitis markers