Analysis Of Hepatitis B Virus Infection And Chemotherapy Related Hepatitis B Reactivation In Lymphoma Compared With Other Solid Cancers

Objective: Hepatitis B virus(HBV) reactivation is a recognized complication of chemotherapy. Many clinical practice guidelines advise HBV testing before starting chemotherapy. HBV reactivation risk differs according to the types of cancer and treatment modality. Recently, non-Hodgkin’s lymphoma(NHL) shows the high incidence of HBV reactivation, particularly B-cell NHL has been taken seriously owing to the highest incidence. Increasingly, HBV reactivation is described in patients with other solid cancers receiving chemotherapy. However, information of HBV reactivation rate in other solid cancers is still limited. We aim to assess the rate of HBV screening and antiviral prophylaxis in cancer patients prior to initiation of chemotherapy with a focus on HBV reactivation, and compare the prevalence of HBV infection as well as reactivation rate in NHL patients with other solid cancers in Fujian Medical University Union Hospital.Methods: We retrospectively analyzed the clinical data of patients with NHL or other solid cancers treated in Fujian Medical University Union Hospital Hematology and Oncology Department between March, 2011 and June, 2014. According to the inclusion and exclusion criteria, important clinical information of cancer patients, such as the levels of HBV DNA, serological markers, liver function and prophylactic antiviral therapy records were collected. The χ2 or Fisher’s exact test was used for analysis of enumeration data.Results: According to the inclusion and exclusion criteria, a total of 1206 patients were enrolled, including 339 patients with non-Hodgkin’s lymphoma(NHL), of which 296 patients were B-cell subtype of NHL, while 103 patients were T-cell subtype of NHL, and 807 patients with other solid cancers.1. Overall 86.3%(1041/1206) of the cancer patients received pre-chemotherapy HBV testing(89.0% for NHL and 85.0% for other solid cancers). 20.7%(216/1041)patients tested positive for HBs Ag. There was a higher prevalence of HBs Ag positive in patients with NHL(24.5%) than that in patients with other solid cancers(18.8%, P=0.031). In addition, a significant difference in HBs Ag status was observed between B-cell NHL and other solid cancers(27.1%vs18.8%, P=0.005), but no differences in HBs Ag status were observed between the T-cell NHL and other solid cancers(17.5% vs18.8%, P=0.762).2. 140 patients who tested positive for HBs Ag received at least two cycle of chemotherapy. Among these patients, HBV DNA was checked in 76.4%(107/140) patients before chemotherapy, while 63.5%(89/140) patients received prophylactic antiviral treatment. No differences in detecting HBV DNA before chemotherapy were observed between the T-cell NHL and other solid cancers(84.5%vs70.7%, P=0.059).However, the antiviral prophylactic rate was 86.2% in B-cell NHL, but only 47.6% in other solid cancers. There is a statistically significant difference between the two groups(P=0.000). Regular monitoring HBV was carried out in 108(77.1%) patients undergoing chemotherapy, the rate of monitoring HBV in patients with B-cell NHL was statistically higher in patients with solid cancers(87.9%vs69.5%, P=0.011).3. A total of 89 HBs Ag positive patients including 44 patients with B-cell NHL and 45 patients with other solid cancers fitted the inclusion criteria and were recruited. 16.9%(15/89) developed HBV reactivation, and no differences between the B-cell NHL and other solid cancers(18.2%vs15.6%, P=0.741). The incidence of hepatitis in B-cell NHL was significantly lower than that in other solid cancers(40.9%vs62.2%, P=0.044), but the incidence of HBV-related hepatitis in B-cell NHL was similar to that in other solid cancers(9.1%vs4.4%, P=0.434).4. For 82 HBs Ag negative/HBc Ab positive patients who received at least two cycle of chemotherapy, 22(26.8%) patients received HBV screening at the onset of chemotherapy, only 2(2.4%) patients received prophylactic antiviral treatment. 23(28.0%) patients were monitored for HBV.And only 1(9.1%) patients developed HBV reactivation in 11 patients who were complied with inclusion and exclusion criteria.Conlusions:1. The current results demonstrated that patients with B-cell NHL had a higher prevalence of HBV infection than patients with other solid cancers.2. Cancer patients with HBs Ag positive, particularly patients with other solid cancers, antiviral prophylactic before chemotherapy and monitoring HBV during chemotherapy were accepted by most Clinicians but needs to be improved. Few clinicians paid attention to HBV reactivation in HBs Ag negative /HBc Ab positive patients.3.The present study revealed incidence of HBV reactivation is similar between B-cell NHL and other solid cancers,it may be related to Clinicians attached great importance to the prophylactic antiviral in NHL.