Analysis Of Clinical Data Of Diffuse Large B-cell Lymphoma With HBV Infection

Objective: To assess the incidence of HBV infection in patients with diffuse large B-cell lymphoma(DLBCL)and to evaluate the clinical characteristics,therapeutic efficacy,prognosis of DLBCL patients with or without hepatitis B virus(HBV)infection,in the era of rituximab(R)treatment.At the sametime,to analyse the situation of HBV reactivation.Methods: The clinical data of 160 DLBCL patients who were preliminarily diagnosed and underwent at least 2 cycles of R-related treatments from January 2012 to July 2019 in Fujian Provincial Hospital were analyzed retrospectively,including: HBV serology,alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),imaging data,etc.Univariate analysis was performed by chi-square test,etc.Propensity scores were matched by using SPSS 22.0,COX regression models were used to analyze relevant predictors,and Kaplan-Meier method was used to draw survival curves.Statistical significance was defined as P <0.05(two-tailed).Result: Among 160 DLBCL patients,45 cases were HBsAg positive(28.1%),and 115 cases were HBsAg negative(71.9%).The age of onset of DLBCL patients in the HBsAg-positive group was lower than that in the HBsAg-negative group(median age:51 years old vs 58 years old,P = 0.017),the proportion of B symptoms was higher(53.3% vs 33.9%,P = 0.024),and the stage of Ann Arbor stage was higher(P = 0.041).There was no difference in the total effective rate and PFS rate between the two groups(P = 0.317 and p = 0.905).In HBsAg positive group,34 patients(75.6%)received entecavir(ETV)for prophylactic anti-hepatitis B virus treatment,3 patients(8.8%)developed HBV reactivation,11 patients(24.4%)received lamivudine(LAM),and 7 patients(63.6%)developed HBV reactivation.The HBV reactivation rate in the ETV group was significantly lower than that in the LAM group(P =0.001).In the ETV group,HBV reactivation occurred mainly after the end of chemotherapy,of which one case occurred HBV-related liver failure;in the LAM group,HBV reactivation occurred mainly during chemotherapy,of which one case died of severe HBV-related liver failure.In the HBsAg-negative group,three cases(2.6%)of HBV reactivation occurred,including two cases in the HBsAg-negative /HBc Ab-negative group,but there were none of HBV-associated hepatitis beacuse of antiviral treatment in time.In terms of survival prognosis,there was a statistical difference in OS rates between the HBsAg-positive group and the HBsAg-negative group after pairing(P =0.043).Through univariate analysis,it revealed older age,PS≥1,later stage of disease,higher IPI index,bone marrow involvement in baseline situation,larger number of extranodal involved tissues or organs,higher β2-MG in serum,and poorer therapeutic efficacy were risk factors for OS.By multivariate analysis,it showed that older age,HBsAg positive,and poorer response to treatment were poor predictors for OS.Conclusion: 1.The incidence of HBsAg-positive patients with DLBCL is significantly higher than that of healthy people.Compared with HBsAg-negative DLBCL patients,HBsAg-positive DLBCL patients have earlier onset age,higher clinical stage of disease,and higher incidence of B symptoms;2.HBV infection is a poor prognostic factor for DLBCL;3.Rituximab treatment increases the incidence of HBV reactivation in DLBCL patients,and some patients with occult HBV infection may also undergo HBV reactivation.4.In HBs Ag-positive patients,more efficient and low-resistance nucleotide analogs should be used,which may need to be prolonged to 18 months after the terminatation of chemotherapy.In HBs Ag-negative/HBc Ab-positive patients,HBV reactivation can be monitored by the improvement of HBV-related detection,and preventive antiviral should be performed if necessary.