Clinical and prognostic analysis of hepatitis B virus infection in diffuse large B-cell lymphoma.
BACKGROUND
Hepatitis B virus (HBV) infection in diffuse large B-cell lymphoma (DLBCL) patients is a common complication in China. However, the clinical relevance of HBV infection with respect to DLBCL disease stages and patient survival remains unclear. The main objective of the current study was to analyze the clinical features and to evaluate the prognostic factors of HBV infection in DLBCL patients.


METHODS
In this retrospective study, DLBCL patients were divided into two groups as HBsAg-positive (n = 81) and HBsAg-negative (n = 181) patients. The HBsAg-positive patients were further divided into two subgroups based on their hepatic function during chemotherapy. Various statistical analyses were used to determine the significance of the relevant clinical parameters.


RESULTS
Compared with the HBsAg-negative group, the HBsAg-positive DLBCL group displayed a younger median onset age (46 year vs 51), more advanced stage at grade III/IV (58% vs 42%, p = 0.016), and more frequent hepatic dysfunction before (21% vs 5.5%, p < 0.001) and during (49.4% vs 16.6%, p < 0.001) chemotherapy. Female DLBCL patients exhibited a higher frequency of HBsAg positivity (p = 0.006). However, in both groups the median overall survival (OS) duration (55.8 vs 66.8 months) and response rates (91% vs 90.4%) were similar. In the HBsAg-positive DLBCL group, the poor prognostic factors were advanced stage (p < 0.001) and hepatic dysfunction during chemotherapy (p = 0.02). The OS of HBsAg-positive patients with hepatic dysfunction during chemotherapy was significantly shorter than those without liver dysfunction (p = 0.016), and the OS rates at 3 years were 48% and 72%, respectively. The use of rituximab did not increase the rates of liver dysfunction in HBsAg-positive DLBCL patients.


CONCLUSIONS
Compared with HBsAg-negative patients, the HBsAg-positive DLBCL patients had earlier onset and more advanced stage. The disease stage and hepatic dysfunction during chemotherapy and were two significant prognostic factors in the HBsAg-positive DLBCL patients. This study suggests that prophylactic treatment of HBV may be of great importance in the cases of HBsAg-positive patients.
Wang
Feng
F
State Key Laboratory of Oncology in Southern China, Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, PRoC. fengwanggz@126.com
Xu
Rui-hua
RH
Luo
Hui-yan
HY
Zhang
Dong-shen
DS
Jiang
Wen-qi
WQ
Huang
Hui-qiang
HQ
Sun
Xiao-fei
XF
Xia
Zhong-jun
ZJ
Guan
Zhong-zhen
ZZ
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D008111:Liver Function Tests; D016393:Lymphoma, B-Cell / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome
D006514:Hepatitis B Surface Antigens