Blood cancers

Consensus group will address hepatitis in haematological malignancy


Moves are underway for a new national consensus group to set up and oversee uniform guidelines for the management of hepatitis in patients with cancer, including haematological malignancy.

This follows the release of recommendations of the 5th European Conference on Infections in Leukaemia (ECIL-5), in relation to the screening, vaccination and treatment of patients with viral hepatitis and haematological malignancy, who are undergoing haemopoietic stem cell transplantation.

The recommendations also set out protocols for the screening and management of haemopoietic stem cell donors. The guidelines are reported in The Lancet Infectious Diseases journal.

The authors reported that the burden of viral hepatitis in patients with haematological malignancies and the weak evidence on which previous guidelines are based had prompted the ECIL-5 to convene a group of experts in the fields of viral hepatitis and of haematological malignancy to specifically address previously unconsidered issues and grade the available quality of evidence according to the Infectious Diseases Society of America grading system.

“The group recommends that all patients should be screened for hepatotropic viruses before haematological treatment and that patients or haemopoietic stem cell donors with markers of past or current viral hepatitis should be assessed by an expert,” they wrote.

Professor Monica Slavin, who leads the Immunocompromised Host Infection service at Royal Melbourne Hospital and is head of the Department of Infectious Diseases at the Peter MacCallum Cancer Centre, was part of the ECIL-5 review team.

She told the limbic that while transplant protocols were already “very strict” in Australia and included screening and testing for hepatitis, the research had highlighted a need for a national approach.

“I think all centres (in Australia) would be doing it (following the ECIL-5 guidelines) but no one has really gone around putting an audit together,” she said.

“And there is no uniform national consensus.”

However this could all be about to change. Specialists from St Vincent’s and the Royal Melbourne hospitals are putting together a steering committee they hope will lead to the establishment of a national consensus group.

It is expected that this group will include a range of specialties including infectious diseases, haematology and transplant.

Professor Slavin said it was hoped the group would endorse the ECIL-5 guidelines and build on this work to address other issues, including paediatrics and other cancers. It would also oversee a national audit “to see whether everyone is on the same page.”

“We wouldn’t be planning to reinvent the wheel, but add to it,” she said. “You can make as many guidelines as you like but you have to know that people are following them.”

She said the ECIL-5 group had provided strong foundations for the steering committee to move forward, and while it was still early days, she did not think it would be difficult to establish a national consensus.

“It won’t take very long because the hard work has already been done and it’s just about value adding,” she said.

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