Clinical Research Of Hepatitis B Virus (HBV) Infection And Outcome In Patients With Hematologic Disease

Objective:This study used a single-center,large-scale sample to analyze the factors that caused HBV(hepatitis B virus)reactivation after chemotherapy in hematological diseases to provide a scientific basis for improving clinical treatment measures.Methods:We performed a retrospective assessment on patients with hematologic diseases who diagnosed and treated in our center,including myeloid malignancies(AML,CML and MDS),lymphoid malignancies(ALL,CLL,MM,NHL,HL),aplastic anemia(AA)and idiopathic thrombocytopenic purpura(ITP).We used clinical epidemiological analysis methods,firstly analyzed the non-drug risk factors which caused HBV reactivation,and then analyzed the relationship between different drugs and HBV reactivation,in order to make suggestions to improve the treatment measures in the future.Results:Totally,2627 patients with hematological malignance were included according to inclusion and exclusion criteria,including 1091 cases of myeloid malignancies(group A),1030 cases of lymphoid malignancies(group B),482 cases of aplastic anemia and primary immune thrombocytopenia(group C),24 cases of other diseases.Among the patients above,HBV reactivation occurred in 61 patients after treatment.Univariate analysis showed that non-drug risk factors associated with HBV reactivation included:sex,disease group,history of hepatitis B,hepatitis B virus serological index,AST(aspartate aminotransferase)and TG(triglyceride).Multiple factor analysis found that the risk of HBV activation was lower in women than in men(OR=0.432,95%CI=0.204-0.915,P=0.028);variance analysis in the 3 groups revealed that risk of HBV reactivation in group B was 15 times higher compared with group C(OR=15.448,95%CI=3.284-72.674,P=0.001),while the risk of HBV reactivation in group A increased(OR=2.417,95%CI=0.471-12.402,P=0.290),but it did not reach a statistically significant level.We also found that TG(triglyceride)>1.70 mmol/l would increase the risk of HBV reactivation(OR=6.442,95%CI=1.328-31.253,P=0.021).Patients who not had a history of hepatitis B virus infection and whose serum HBeAb antibody were negtive and whose AST were within the reference range have a low risk of HBV reactivation.Only the group B was suitable for analyzing the relationship between drugs and the risk of HBV reactivaton.After controlling possible confounding factors,the results showed that the combination of corticosteroid and rituximab increased the risk of HBV reactivation(OR=7.64,95%CI=1.11-52.49).While the use of corticosteroid-containing regimen or rituximab-containing regimen increased the risk of HBV reactivation,but it did not reach a statistically significant level.Further analysis of group B revealed that the frequency of HBV reactivation in NHL(non Hodgkin lymphoma)after chemotherapy was the highest(31/49).Univariate analysis found that risk factors include:gender,history of hepatitis B virus infection,HBsAg-positive,HBsAb-negative,HBeAg-positive,HBeAb-positive,HBcAb-positive,and lack of antiviral therapy.After controlling possible confounding factors,the intensity of HBV reactivation caused by different chemotherapy regimens differs,the regimen containing corticosteroid and rituximab was the highest(OR=10.444,95%CI=0.876-124.522,P=0.062),others did not reach statistical significance level.And female patients had lower risk of HBV reactivation compared with the male(OR=0.163,95%CI=0.041-0.643,P=0.010).Antiviral Treatment had a protective effect(OR=0.128,95%CI=0.022-0.750,P=0.023).HBsAg positive was another risk factor(OR=19.942,95%CI=2.675-148.685,P=0.004).Conclusion:Sex,HBsAg positive,elevated AST and TG were risk factors for HBV reactivation.Prophylactic antiviral therapy can reduce the risk of HBV reactivation.The reactivation rate of HBV in lymphatic malignances is significantly higher than other hematologic maligances.The chemotherapy regime which contains rituximab and corticosteroid simultaneously increased the risk of HBV reactivation.This study found that high dose of tyiglyceride before chemotheray increased the risk of HBV reactivation.