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    Home > Active Ingredient News > Antitumor Therapy > Professor Huang Liang: Prevention and treatment strategies for HBV reactivation related to CAR-T cell therapy The 6th Anti-leukemia·Lymphoma International Summit Forum

    Professor Huang Liang: Prevention and treatment strategies for HBV reactivation related to CAR-T cell therapy The 6th Anti-leukemia·Lymphoma International Summit Forum

    • Last Update: 2021-08-06
    • Source: Internet
    • Author: User
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    In order to further promote the exchanges and development in the field of leukemia and lymphoma at home and abroad, the "Sixth Anti-leukemia·Lymphoma International Summit Forum and CSCO Anti-Leukemia Alliance & Anti-Lymphoma Alliance Tour-Harbin Station" will be held on July 8, 2021 -10 held in Harbin
    .

    This forum brought together many outstanding leukemia and lymphoma experts at home and abroad to conduct in-depth discussions and exchanges on new drug development and clinical applications
    .

    At this forum, Professor Huang Liang from Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology gave a special report on "CAR-T cell therapy-related HBV reactivation prevention and treatment strategies".
    Yimaitong organized the main content as follows
    .

    HBV reactivation in CAR-T cell therapy During clinical treatment, the use of CAR-T cell therapy may cause hepatitis B virus (HBV) reactivation
    .

    Many domestic research centers have provided a wealth of evidence-based evidence and found that even if HBV chronic infection (HBsAg+) is used for prevention with nucleoside analogs (NAs), the risk of HBV reactivation is still higher after receiving CAR-T cell therapy (>10%), can be manifested as hepatitis or asymptomatic HBV-DNA elevation, and most HBV reactivation occurs within half a year after CAR-T cell infusion
    .

    Therefore, Professor Huang Liang said that even after receiving NAs preventive treatment, HBV activation should be closely monitored after CAR-T cell therapy
    .

    For patients who have recovered from hepatitis B (HBsAg- and HBcAb+), NAs is rarely used for prevention in clinical practice.
    After CAR-T cell therapy, more than 10% of patients still have HBV reactivation.
    If no intervention is taken, Patients can progress to the stage of liver failure in a short period of time, which requires early identification and intervention
    .

    Entecavir can effectively prevent HBV reactivation after CAR-T cell therapy, but inappropriate deactivation of NAs may lead to the risk of HBV reactivation
    .

    After HBV is reactivated, NAs will still be effective after the addition of NAs
    .

    In addition, studies have shown that CAR-T cell therapy has no significant liver toxicity, and HBV infection does not increase the liver toxicity of CAR-T cell therapy
    .

    Professor Huang Liang said that CAR-T cell therapy is equally effective for patients with HBV infection
    .

    Recommendations for the prevention and treatment of HBV reactivation in CAR-T cell therapy Professor Huang Liang said that for the prevention and treatment of HBV reactivation in CAR-T cell therapy, it is necessary to first identify the high-risk groups of HBV reactivation in CAR-T cell therapy, and then according to different The population uses NAs preventively and develops an individualized plan
    .

    High-risk groups should be routinely screened for HBV serological markers (HBsAg, HBsAb and HBcAb), HBV DNA and liver function, and comprehensively evaluate the risk of HBV reactivation
    .

    HBsAg positive and HBV DNA positive are virological risk factors for HBV reactivation
    .

    For chronic infection of HBV, NAs should be used prophylactically
    .

    If HBV DNA is negative, NAs can be used preventively or preemptive treatment strategies can be used in patients who have recovered from hepatitis B.
    Patients with HBV DNA positive, poor monitoring compliance, HBsAb<56.
    48 mlU/mL and HBcAb≥6.
    41 IU/mL should be used prophylactically.

    .

    NAs is given one week before pretreatment.
    The course of treatment depends on the duration of the patient's B lymphocyte depletion.
    It is necessary to monitor the peripheral blood lymphocyte subsets.
    When the peripheral blood B lymphocytes recover, continue to use NAs prophylactically for 12 months
    .

    If HBV reactivation occurs in patients who have not been treated with NAs in the past, NAs treatment should be initiated immediately; if HBV reactivation occurs in patients who have been treated with NAs in the past, they should be switched to or combined with cross-resistant NAs
    .

    For the monitoring of HBV reactivation, HBV chronic infection and hepatitis B patients who adopt preventive strategies should monitor HBV DNA and HBV serological markers (HBsAg, HBsAg, HBV serological markers) every 1-3 months after CAR-T cell infusion.
    HBsAb and HBcAb) and liver function were monitored once every 1 month within half a year of reinfusion, and once every 3 months after half a year of reinfusion, and continued to be monitored until 12 months after stopping NAs
    .

    Those recovering from hepatitis B who have not received preventive strategies should actively use the above monitoring methods until 12 months after the recovery of peripheral blood B lymphocytes
    .

    Professor Huang Liang said that in the selection of treatment options, it is necessary to comprehensively evaluate the patient’s age, systemic diseases and other liver problems and the impact of treatment on HBV reactivation, and consult the liver disease department for advice, pay attention to patient education, and improve patient prevention and monitoring.
    Compliance, timely identification of rare adverse reactions of NAs (such as renal insufficiency, low phosphorus bone disease, myositis, rhabdomyolysis, lactic acidosis, etc.
    ), to avoid the risks caused by irregular treatment and long-term medication
    .

    In summary, CAR-T cell therapy may have reactivation of HBV in clinical practice.
    The prevention and treatment should first identify high-risk populations who need prophylactic use of NAs in CAR-T cell therapy, and then comprehensively evaluate age, systemic diseases, and patient compliance.
    To reduce the risk of drug-related adverse reactions as much as possible by formulating individualized preventive medication plans and conducting standardized treatment based on various factors such as sex
    .

    Professor Huang Liang, Ph.
    D.
    , Deputy Chief Physician, Master's Supervisor, Deputy Director of the Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Youth Committee of the Hematology Branch of the Chinese Medical Association, Youth Committee and Secretary of the Hematology Committee of the Chinese Anti-Cancer Association The author has published more than ten SCI papers in Cell Research, Blood Cancer Journal and other journals.
    He has been funded by the National Natural Science Foundation of China Youth Project, the General Project and the Ministry of Science and Technology 863 Young Scientist Special Project.
    Received the 2018 MMAAP Foundation Hematology Fellowship Award, 2018 ASH and the 2019 ASCO Abstract Merit Award, a visiting scholar from the City of Hope National Medical Center stamped "Read the original text", and we make progress together
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