Clinical features of hepatitis E infections in patients with hematological disorders

Hepatitis E virus is increasingly being reported to cause chronic infection in immunocompromised patients. However, less is known about patients with underlying hematologic disease. In particular, the impact of hepatitis E infection on oncologic therapy has been poorly described. In this retrospective single-center analysis, we analyzed 35 hematological patients with hepatitis E, including 20 patients under active oncologic treatment and 15 patients who were in the post-treatment follow-up or under active surveillance. The primary aim was to describe the clinical courses with particular focus on any hepatitis E-related therapy modifications of cancer-directed therapy. In the majority (60%) of patients who were under active oncological treatment, hepatitis Erelated therapy modifications were made with 25% of deaths due to progression of hematological disease. In patients with concomitant oncological treatment, no hepatitis Erelated death occurred. In contrast, two patients in the follow-up group died from hepatitis Eassociated acute-on-chronic liver failure. Chronic hepatitis E was observed in 34% of all cases and 43% received ribavirin therapy, of those 27% achieved sustained virologic response. CD20-directed therapy was the only independent risk factor for developing chronic hepatitis E. We conclude that CD20-directed treatment at any time point is a risk factor for developing chronic hepatitis E. Nevertheless, since mortality from the progression of hematological disease was higher than hepatitis E-related mortality, we suggest a careful case-by-case decision of cancer-treatment modification. Patients in post-treatment follow-up phase may also suffer from severe courses and hepatitis E chronification occurs as frequently as in patients undergoing active therapy.