Hepatitis B Virus Reactivation In Diffuse Large B Cell Lymphoma Patients With Prior Resolved Hepatitis B Undergoing Anticancer Therapy With Or Without Rituximab

Objective:To investigate Hepatitis B Virus Reactivation and its clinical characteristics in diffuse large-B-cell lymphoma (DLBCL) patients with prior resolved Hepatitis B undergoing anticancer therapy with or without rituximab,and to explore its possible impact factors and therapeutic strategies.Methods:this was a a retrospective study including245diffuse large-B-cell lymphoma patients with prior resolved Hepatitis(HBsAg-/HBcAb+)from February2004to August2013period.All patients were followed up to understand the living conditions. The baseline and reactivation data of patients who have the Virus reactivation were recorded,and univariate and multivariate analysis were used to explore the epidemic and prognostic factors.Results:1. Among629DLBCL patients collected,in our hospital from February2004and August2013,136cases (21.62%) were HBsAg+, with a higher rate than the prevalence in the general population(7.2%).245DLBCL patients(38.95%) had prior resolved Hepatitis B,with a similar rate with the prevalence in the general population(34.1%). Among these245patients,169patients were companied with HBsAb+(69%),while76 patients were companied with HBsAb-(31%);73patients were companied with HBeAb+(29.8%).129of the245patients (57.2%) had the HBV-DNA testing, and all were negative. The majority of patients (96.3%) at baseline did not exist liver damage.2. In DLBCL patients, the total rate of virus reactivation in resolved patients was significantly lower than in HBsAg+patients (2.86%Vs11.76%, P=0.001). Among patients accepting R+CHOP-like regimen, the rate of virus reactivation in resolved patients was significantly lower than in HBsAg+patients (3.5%Vs17.11%, P=0.002).3. In DLBCL patients(38.95%) with prior resolved Hepatitis B,R-CHOP like regimen had a better OS (median OS26(4-93)months Vs16(2-98)months, P=0.043) And PFS (median PFS20(2-92) months Vs10(2-98) months, P=0.025) than CHOP-like regimen, without adding the rate of virus reactivation (3.5%Vs1.3%, P=0.449)4. Among patients receiving R+CHOP-like regimen, patients with virus reactivation had a high HBeAb+rate (100%Vs10.87%, P=0.004), a higher ECOG (P=0.014), a high rate of B symptoms (80%Vs29.41%, P=0.033), a more serious liver disfunction (P<0.001) and a low rate of HBsAb+(20%Vs70.59%, P=0.074) by comparing with the inactive.5. Among patients receiving R+CHOP-like regimen, patients with virus reactivation had a less OS (median OS13months Vs24months, P<0.01)and no difference in PFS (median PFS13months Vs19months, P=0.063) by comparing with the inactive. The mortality caused by virus reactivation was80%.6. For patients receiving R+CHOP-like regimen, reactivation of hepatitis B virus (P<0.01, RR=26.325), higher IPI score (P<0.01, RR=5.439), pathological type Non-GCB (P=0.012, RR=5.988) were risk factors affecting the OS, while more circles of rituximab therapy (P=0.009, RR=0.654) was considered as a protective factor. Using more then one line treatment before rituximab (P=0.004RR=3.094) and higher IPI score (P=0.002RR=1.154) prompted a higher risk of disease progression. ConclusionThe hepatitis B virus infection rate was60.57%in DLBCL. of which2/3were resolved. Among DLBCL patients with resolved hepatitis B, patients accepting R+CHOP-like regimen had a superior OS and PFS, without a increased risk of virus reactivation. Hepatitis B virus reactivation was considered as a important risk factor in these receiving R+CHOP-like regimen, and always predicted a poor prognosis (mortality80%). HBsAb negative, HBeAb positive and the presence of B symptoms were possible risk factors predicting the hepatitis B virus reactivation in such patients. For DLBCL patients with resolved hepatitis B, HBV-DNA and serum HBsAg should be monitored during the chemotherapy duration (especially those with positive HBeAb and negative HBsAb), once the virus reactived or HBsAg turned positive, antiviral drugs should be implemented immediately.