Chronic hepatitis B is associated with an increased risk of B‐cell non‐Hodgkin's lymphoma and multiple myeloma

Abstract

Background: Chronic hepatitis B has been linked to lymphoma with contradictory results.Aim: To investigate the association between chronic hepatitis B and lymphoma by using a nationwide population-based cohort. Methods: Records of patients diagnosed with chronic hepatitis B (hepatitis B virus[HBV] cohort) or without (non-HBV cohort) during 2004-2007 were retrieved from the Taiwan National Health Insurance Research Database. Age, sex, comorbidities, and medical visits were matched using propensity scores between both cohorts, and they were followed up longitudinally until 2012 to determine any new lymphoma development.Results: A total of 203 031 patients were included in each cohort with a mean follow-up of 7-9 years. The lymphoma incidence rate was significantly higher in the HBV cohort than in the non-HBV cohort (29.4 vs 15.9 per 100 000 person-years, P < 0.0001). After adjustment for comorbidities and medical visits, HBV infection was found to be an independent risk factor associated with the development of lymphoma (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.76-2.43, P < 0.0001) and non-Hodgkin's lymphoma (HR: 2.18, 95% CI: 1.80-2.65, P < 0.0001); specifically with an increased risk of diffuse large B-cell lymphoma (HR: 2.69, 95% CI: 2.05-3.52, P < 0.0001), other B-cell lymphoma (HR: 3.11, 95% CI:1.89-5.11, P < 0.0001), and also for multiple myeloma (HR: 1.63, 95% CI: 1.10-2.42, P = 0.016). The association was significant even after excluding lymphoma development within the first year (HR: 2.08, 95% CI: 1.75-2.47, P < 0.0001). Conclusions:Chronic hepatitis B is temporally associated with a 2-fold increased risk of lymphoma, particularly with B-cell non-Hodgkin's lymphoma, and also an increased risk for multiple myeloma.

Nonliver Comorbidities in Patients With Chronic Hepatitis B

“…CHB has also been associated with a higher prevalence of malignancy, including colorectal, pancreatic, gallbladder and biliary duct, kidney, and ovarian cancer, as well as Hodgkin's lymphoma, non‐Hodgkin's lymphoma, and multiple myeloma . There has been some debate regarding the association of CHB and lymphoma .…”

“…However, in 2002, Kim et al performed a case‐control study in Korea and found that the risk for B cell non‐Hodgkin's lymphoma was increased among patients with CHB, with an adjusted odds ratio (OR) of 3.30 (95% CI: 1.69‐6.45). Further, in a claims‐based study conducted in Taiwan comparing patients with CHB against those without, Su et al found HBV to be a risk factor for both lymphoma (hazard ratio [HR] 2.07 [95% CI: 1.76‐2.43]) and non‐Hodgkin's lymphoma (HR 2.18 [95% CI: 1.80‐2.65]), as well as for multiple myeloma. Several other studies have also corroborated the finding that CHB is linked to development of lymphoma .…”

“…14 CHB has also been associated with a higher prevalence of malignancy, including colorectal, pancreatic, gallbladder and biliary duct, kidney, and ovarian cancer, as well as Hodgkin's lymphoma, non-Hodgkin's lymphoma, and review multiple myeloma. 13,[15][16][17][18][19] There has been some debate regarding the association of CHB and lymphoma. [19][20][21][22] In a Danish national registry-based study, Andersen et al 21 found that compared with patients without HBV, patients with HBV did not demonstrate statistically significant increased risk for all-type cancer (incidence rate ratio [IRR] 1.10 [95% confidence interval (CI): 0.92-1.31]) and non-Hodgkin's lymphoma (IRR 1.22 [95% CI: 0.42-3.55]).…”

“…13,[15][16][17][18][19] There has been some debate regarding the association of CHB and lymphoma. [19][20][21][22] In a Danish national registry-based study, Andersen et al 21 found that compared with patients without HBV, patients with HBV did not demonstrate statistically significant increased risk for all-type cancer (incidence rate ratio [IRR] 1.10 [95% confidence interval (CI): 0.92-1.31]) and non-Hodgkin's lymphoma (IRR 1.22 [95% CI: 0.42-3.55]). However, in 2002, Kim et al 20 performed a case-control study in Korea and found that the risk for B cell non-Hodgkin's lymphoma was increased among patients with CHB, with an adjusted odds ratio (OR) of 3.30 (95% CI: 1.69-6.45).…”

Letter: hepatitis B virus infection and risk of multiple myeloma—a meta‐analysis of cohort studies

“…We read with great interest the recent large-scale cohort study by Su et al 1 reporting that chronic hepatitis B virus (HBV) infection is an independent risk factor for multiple myeloma (MM) (hazard ratio:…”