High prevalence of past hepatitis B virus infection in diffuse large B cell lymphoma: a retrospective study from Italy

Abstract

Studies from high endemic areas, mostly China, indicate that surface antigen positive (HBsAgpos) chronic hepatitis B virus (HBV) infection is associated with an increased risk of developing diffuse large B-cell lymphoma (DLBCL), whereas studies in low endemic areas have provided conflicting results. Past infection, serologically defined by negative HBsAg and positive anti-core antibody (HBsAgnegHBcAbpos), has also been suggested to increase the risk of B-cell non-Hodgkin’s lymphoma (NHL) in high endemic areas. We retrospectively reviewed unselected clinical records of 253 patients with DLBCL (54% male, aged 60.3 ± 14.6 years at diagnosis) and 694 patients with different types of indolent B-cell NHL (46% male, aged 61.7 ± 12.8 years). Patients were seen at a single center in Italy between 2001 and 2022 and HBV serological status (HBsAg, HBsAb, HBcAb, HBeAg, HBeAb, and HBV DNA) was analyzed through enzyme-linked immunosorbent assays and molecular assays; patients infected with hepatitis C virus or human immunodeficiency virus were excluded. We used an unconditional multiple logistic regression model including as matching variables gender, age at diagnosis, immigrant status, and HBV serological status. Patients with DLBCL had, compared to indolent NHL, a higher prevalence of HBsAgpos active infection (odds ratio (OR) 2.8, 95% confidence interval (95% CI) 1.2–6.3, p = 0.014). Strikingly, patients with DLBCL had also a significantly higher prevalence of past infection (OR 2.4, 95% CI 1.5–4.0, p = 0.0006). Male gender was associated with increased risk of DLBCL independently of the HBV serological status. These findings suggest that both past and active HBV infection may increase the risk of DLBCL in a low endemic area. Our study needs confirmation by studies in areas or populations with different rates of chronic or past HBV infection.

The Possible Role of Pathogens and Chronic Immune Stimulation in the Development of Diffuse Large B-Cell Lymphoma

“…It has been reported that ongoing HBV infection can potentiate the resistance to S-phase arrest, causing a resistance to chemotherapeutic agents [ 86 ]. The frequency of past HBV infections in a large DLBCL cohort is reported to be 16.8% by an Italian study [ 22 ]. It has been documented that past HBV infection increases the chances of developing DLBCL with an odds ratio of 2.25 [ 82 ].…”

The association of the hepatitis B virus infection and diffuse large B-cell lymphoma

“…Studies have found that HBV infection increased the risk of non-Hodgkin lymphoma and that the positive rate of HBsAg in non-Hodgkin lymphoma was 2–3 times higher than in the healthy population. 4 , 5 Some research data has suggested that HBV infection may affect patient outcomes,but other researchers have proposed different views. 6 , 7 Lemaitre’s study suggested that HBsAg(-) cases and HBsAg (+) cases had a similar survival time, and viral infection did not affect the prognoses of patients.…”