title: Lymphocyte/monocyte ratio and cycles of rituximab-containing therapy are risk factors for hepatitis B virus reactivation in patients with diffuse large B-cell lymphoma and resolved hepatitis B.
abstract: Reactivation of hepatitis B virus (HBV) following rituximab (R)-containing chemotherapy for lymphoma is a major concern, and risk factors remain to be defined. We enrolled 190 patients diagnosed with diffuse large B-cell lymphoma (DLBCL) and resolved hepatitis B, receiving first-line R-CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone)-based regimens. Twenty-seven patients (14.2%) developed HBV reactivation during a median follow-up of 23.6 months. Two independent risk factors were identified: cycles of rituximab>8 (hazard ratio [HR], 2.797; 95% confidence interval [CI], 1.184-6.612) and lymphocyte/monocyte ratio (LMR)<2.50 (HR, 2.733; 95% CI, 1.122-6.657). Two-year overall survival in patients with or without HBV reactivation was 53.8% vs. 77.6% (p=0.025). Regarding the negative impact on clinical outcome, patients at "super high risk" of HBV reactivation, including those receiving more than eight cycles of R and having low LMR at diagnosis, may warrant first priority for antiviral prophylaxis.
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Chia-Yun
authors.initials: CY
authors.lastname: Wu
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Liang-Tsai
authors.initials: LT
authors.lastname: Hsiao
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.|c Division of Transfusion Medicine, Taipei Veterans General Hospital , Taipei , Taiwan.
authors.forename: Tzeon-Jye
authors.initials: TJ
authors.lastname: Chiou
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Jyh-Pyng
authors.initials: JP
authors.lastname: Gau
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Jin-Hwang
authors.initials: JH
authors.lastname: Liu
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Yuan-Bin
authors.initials: YB
authors.lastname: Yu
authors.affiliation: d Department of Nursing , Taipei Veterans General Hospital , Taipei , Taiwan.
authors.forename: Yi-Tsui
authors.initials: YT
authors.lastname: Wu
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.|e Division of Hematology and Medical Oncology, Department of Medicine , Taipei Veterans General Hospital , Taoyuan Branch, Taoyuan , Taiwan.
authors.forename: Yu-Chung
authors.initials: YC
authors.lastname: Huang
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Man-Hsin
authors.initials: MH
authors.lastname: Hung
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Po-Min
authors.initials: PM
authors.lastname: Chen
authors.affiliation: b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.|f Division of Gastroenterology, Department of Medicine , Taipei Veterans General Hospital , Taipei , Taiwan.
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.affiliation: a Division of Hematology and Oncology, Taipei Veterans General Hospital , Taipei , Taiwan.|b Institute of Clinical Medicine, National Yang-Ming University , Taipei , Taiwan.
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000821:virology*; D006515:Hepatitis B virus; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008214:Lymphocytes; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood* / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009000:Monocytes; D009367:Neoplasm Staging; D011292:Premedication; D012189:Retrospective Studies; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: HBV reactivation; diffuse large B-cell lymphoma; lymphocyte/monocyte ratio; resolved hepatitis B; rituximab