| Objective:Diffuse large B-cell lymphoma,(DLBCL) is one of the most common subtype of adult non-hodgkin's lymphoma(non Hodgkin lymphoma, NHL),, accounted for about 30-40% of the adult NHL. Presently,many studies confirmed that the occurrence of NHL was correlated with HBV infection. For high endemic areas of HBV infection in China,there was few report on the influnce of the disease outcome and prognosis of patients with DLBCL.We analyzed 521 patients with diffuse large B-cell lymphoma who had received histological diagnosis and treatment in three hospitals of Tianjin from June 2009 to January 2014.Atotal of 235 patients with DLBCL was up to standard. This study retrospectively analyzed the liver function damage and the clinical features and prognosis of patients with DLBCL who infected HBV or not. Methods:We analyzed 521 patients with diffuse large B-cell lymphoma who had received histological diagnosis and treatment in three hospitals of Tianjin from June 2009 to January 2014.,98 patients(18.8%) HBs Ag-positive, a total of 235 patients with DLBCL was up to standard.235 cases of DLBCL patients were divided into two groups as HBs Ag-positive(n = 79) and HBs Ag-negative(n = 156) patients. All patients were accepted CHOP(cyclophosphamide,anthracycline-Based, vinblastine and prednisone) or R- CHOP(CHOP combined rituxan), chemotherapy cycle?4 patients with liver function impaired were given glutathione, glycyrrhizic acid, bicyclol and other lived-potected enzyme treatment,combined anti HBV therapy or not. Collect clinical characteristics of two groups,including: age, gender, physical ability score, clinical stage, number of knots outside involvement, bone marrow involvement, splenic involvement, hepatic involvement, lactate dehydrogenase(LDH), ?2 microglobulin(?2-MG), IPI score, B symptoms, pathological type, chemotherapy, combined with radiotherapy, short-term effects,lived impaired before and during chemotherapy. The disease and survival condition with telephone follow-up,the deadline was January 1, 2015. The application of SPSS 17.0 software for statistical analysis. Groups of survival rates with log- rank test. Survival analysis by Kaplan Meier method, multi-factor analysis by using the Cox proportional hazards model. P Values <0.05 were considered to be significant. Results:1?The infection rate of HBV in DLBCL patients was 18.8%, higher than 7.81% of our ordinary people.2?Compared with the HBs Ag-negative group, the HBs Ag-positive DLBCL group displayed a younger median onset age(47 year vs 58,P<0.001), more spleen involvement(26.3%vs15.1%,p=0.039), more liver involvement(11.8%vs4.4%, p=0.034) The difference was not significant.3?Compared with the HBs Ag-negative group, the HBs Ag-positive DLBCL group more frequent liver function damage rates during chemotherapy(47.4%vs 26.2%, p =0.001) which had significant difference.4?Compared with the HBs Ag-negative group, the HBs Ag-positive DLBCL group more frequent liver function damage rates during chemotherapy(60.0%vs 29.0%,P=0.008) which had significant difference. Mabthera in HBs Ag negative group did not increase the risk of liver damage during chemotherapy(29.1%vs 21.4%,P=0.293). There was no statistically significant difference.5?Compared with the HBs Ag-negative group, HBV reactivative rate was higher in the HBs Ag-positive group(11.8% vs2.5%,P=0.006),which had significant difference…6?in the two groups, younger age at onset, male, late clinical stage, chemotherapy combined with rituximab increased the rate of HBV reactivation, but the difference was not statistically significant(P > 0.05). Compared with HBs Ag positive group, liver involvement increased the HBV reactivation in HBs Ag negative group(75.0% vs 44.4% P=0.676),which had no significant difference…7 Median overall survival(0S) of HBs Ag-positive group was 48 months and 3-year overall survival rate was 64.1%,while the 0S of HBs Ag-negative group was 42 months and 3-year overall survival rate was 61.7%,(?2=0.998,P=0.320)which showed no significant difference,and the same was progression-free survival(PFS) rate.(?2=2.658,P=0.103)?8 In the HBs Ag-positive DLBCL group, Multivariate analysis by Cox regression showed that age >60 years,positive B symptoms and liver involvement are related to the prognosis.While, hepatic dysfunction has not influence on survival. Conclusions:1?The infection rate of HBV in DLBCL patients is high. HBV may play a role in the incidence of DLBCL2?Compared with the HBs Ag-negative group,the HBs Ag-positive DLBCL patients had earlier onset, more live and spleen involvement and more hepatic dysfunction during chemotherapy. The prophylactic treatment of HBV was suggested in the cases of HBs Ag-positive patients.3?HBV reactivative rate was higher in the HBs Ag-positive group. younger age at onset, male, late clinical stage, chemotherapy combined with rituximab increased the rate of HBV reactivation,in two groups., Liver involvement increased the HBV reactivation in HBs Ag negative group4?There was no significant difference in overall survival and progression free survival between HBs Ag positive DLBCL patients and HBs Ag negative patients5?The prophylactic treatment of HBV was suggested in the cases of HBs Ag-positive patients,especially in the patients applied rituximab combined with chemotherapy, to reduce the incidence of liver damage.and HBV reactivation... |
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