The Relationship Between Hepatitis B Virus Infection And Diffuse Large-B Cell Lymphoma

Objective:This study was to analyze the clinical features of hepatitis B virus (HBV) infection in diffuse large B-cell lymphoma (DLBCL) patients.Methods:437patients with DLBCL who were initially diagnosed in the First Affiliated Hospital of Zhejiang University from February2004to March2012were enrolled. We retrospectively analyzed the clinical characteristics of these patients to calculate the HBV infection rate (%). According to the expression of HBsAg,222patients who received four cycles of chemotherapy at least were divided into two groups to reveal the differences between HBsAg-positive (n=49) and HBsAg-negative (n=173) group. Follow-up study was preceded via phone to achieve data for survival status. Results:1、 Among the437cases studied, HBsAg-positive rate (%) was20.8%, previous HBV infection rate (%) was37.8%.2、 Among the222cases selected,49cases (22.1%) were HBsAg-positive and173(77.9%) were HBsAg-negative. Compared with the HBsAg-negative group, the HBsAg-positive DLBCL displayed a younger age (85.7%vs64.2%), more advanced stage at grade III/IV (73.5%vs53.2%), more spleen involvement (10.2%vs2.3%) and more frequent hepatic dysfunction before (20.4%vs5.8%) and during (38.8%vs17.9%) chemotherapy, with significantly differences (P <0.05).3、 The median survival duration for HBsAg-positive and HBsAg-negative groups were22and21months. The overall survival durations in both groups were similar, without significantly differences (P>0.05).4、 The rates of hepatitis in the HBsAg-positive and HBsAg-negative groups were49.0%and29.5%; The rates of HBV reactivation were14.3%and2.9%, with significantly differences (P <0.05). The use of rituximab can increase the rate of hepatitis in the HBsAg-negative group (35.8%vs20.8%), with significantly differences (P <0.05).5、 A younger age, sex of male, more advanced stage and the use of rituximab can increase the rates of HBV reactivation in both groups; HBV-DNA>105can increase the rate of HBV reactivation in the HBsAg-positive group(42.9%vs26.2%); more liver involvement can increase the rate of HBV reactivation in the HBsAg-negative group(25.0%vs1.8%), while all of above without significantly differences (P>0.05). HBeAg-positive didn’t increase the rate of HBV reactivation in the HBsAg-positive group.6、 In the HBsAg-positive group,36cases(36/49,73.5%) received preventive antiviral treatment,13cases (13/49,26.5%) didn’t. Twelve cases(12/36,33.3%) and6case (6/13,46.2%) appeared hepatitis; Four cases (4/36,11.1%) and3case (3/13,23.1%) appeared HBV reactivation, while without significantly differences (P>0.05). Conclusion:This study shows that the incidence of HBV in DLBCL is higher than that in healthy people, HBV infection may play an etiologic role in the induction of DLBCL, especially in the younger, advance stages, spleen involvement and hepatitis before and during chemotherapy patients. There was no obvious difference in the survival rate. The rates of hepatitis and HBV reactivation in the HBsAg-positive group are higher than the negative group. Rituximab can increase the rate of hepatitis in the HBsAg-negative group. A younger age, sex of male, more advanced stage and the use of rituximab are prone to increase the rates of HBV reactivation in both groups; more liver involvement has the trend to increase the rates of HBV reactivation in the HBsAg-negative group; HBV-DNA>105has the trend to increase the rates of HBV reactivation in the HBsAg-positive group. Preventive antiviral treatment is prone to decrease the possibility of hepatitis and HBV reactivation.