title: The impact of hepatitis B virus infection and vaccination on the development of non-Hodgkin lymphoma.
abstract: Hepatitis B virus (HBV) infection has been documented as a risk factor for non-Hodgkin lymphoma (NHL). However, there are few large cohort studies, and there is no report about the impact of HBV vaccination. We conducted this study to evaluate these issues. We used the nationwide cohort of the Taiwan National Health Insurance Research Database for 1997-2013. We compared the incidence and the risk of developing NHL and CD20+aggressive lymphoma between HBV and non-HBV cohorts. The hazard ratios (HRs) were computed using Cox proportional hazards models. We matched these two large cohorts to reconfirm the data. We also compared the incidence of NHL between cohorts born before and after the inception of universal HBV vaccination. We found that HBV infection increased the risk for developing NHL and CD20+aggressive lymphoma, with HRs of 4.14 and 5.52, with a higher incidence of 17.07 and 13.9 per 100 000 person-years, respectively, compared to the non-HBV cohort. The incidence of NHL in the cohort born in the era before universal HBV vaccination was higher with 1.85 per 100 000 person-years compared to 0.74 in the cohort born later aged younger than 20. Our study confirms that HBV confers a greater risk for developing NHL, especially CD20+aggressive lymphoma. The impact of HBV vaccination is protective against lymphoma development in the teenagers in an endemic area, but longer follow-up is needed for older age.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-E
authors.identifier: 0000-0001-5921-5346
authors.initials: CE
authors.lastname: Huang
authors.affiliation: Departement of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.|Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.|School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan.|Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Y-H
authors.identifier: 0000-0002-8080-0504
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Y-Y
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Chang
authors.affiliation: Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: K-J
authors.initials: KJ
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.|Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-H
authors.initials: CH
authors.lastname: Lu
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: K-D
authors.initials: KD
authors.lastname: Lee
authors.affiliation: Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan.|Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.|Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: P-C
authors.initials: PC
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: C-C
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000276:immunology* / Q000517:prevention & control / Q000821:virology; D006515:Hepatitis B virus / Q000276:immunology*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012306:Risk; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology; D014611:Vaccination; D055815:Young Adult
keywords: diffuse large B-cell lymphoma; hepatitis B; non-Hodgkin lymphoma; risk; vaccination