Negative effect of hepatitis in overall and progression-free survival among patients with diffuse large B-cell lymphoma

Abstract

BackgroundHepatitis B virus (HBV) is one of the most prevalent and serious infections worldwide. HBV reactivation is a serious complication for lymphoma patients who are being treated with rituximab-containing regimen. Since the impact of HBV has not been fully evaluated on the prognosis of diffuse large B cell lymphoma (DLBCL), this study examined the effect of the hepatitis infection on the progression-free survival (PFS) and overall survival (OS) in patients with DLBCL who received rituximab-containing chemotherapy.MethodsThis retrospective cohort study was conducted at Princess Noorah Oncology Center, Jeddah by reviewing all medical records of 172 DLBCL diagnosed patients and recieved Rituximab-containing chemotherapy dated from January 2009 to February 2016.ResultsOut of 172 patients, 53 were found positive in hepatitis serology. The 12 of those were HBsAg-positive and 41 were HBcAb-positive. Hepatitis reactivation was observed in 1% of the patients (i.e., 2 out of 172) and both of them were HBsAg-positive. Thus, the risk of hepatitis reactivation among the HBsAg-positive patients was 17% (i.e., 2 out of 12). The predicted 3-year PFS for HBsAg-positive and HBcAb-positive were 52% (± 8%), while 76% (± 4) for HBsAg-negative and HBcAb-negative patients. On the other hand, the predicted 3-year OS for HBsAg and HBcAb-negative group is 93% (±3) while for HBsAg-positive and HBcAb-positive is 77% (±7), respectively.ConclusionThe present study demonstrated a low HBV reactivation rate of 1% exclusively in 2 patients with HBsAg-positive status diagnosed with DLBCL and receiving R-CHOP chemotherapy.

<p>Clinical Analysis and Prognostic Significance of Hepatitis B Virus Infections with Diffuse Large B-Cell Lymphoma</p>

“…In our study, there are three of HVB positive patients (all come from HBsAg-positive) experience HBV reactivation with a 10folds or more increase in the HBV-DNA when compared to their lowest level. This finding is relatively consistent with the result reported in the study of Al-Mansour M M. 41 During continuous antiviral therapy, all of them were under control through reducing dose and extend interval of chemotherapy. So far, one of them was alive still and no recurrent are observed after received eight cycles of chemotherapy.…”

Pharmacotherapy-Induced Hepatitis B Reactivation Among Patients With Prior Functional Cure: A Systematic Review

“…A total of 37 studies including 3601 patients with resolved HBV infection evaluated the use of rituximab for hematological malignancies or solid tumors, generally in addition to other cytotoxic chemotherapeutic agents (Table 2). 8,9,18-52 In most of the studies, patients did not receive prophylaxis. The incidence of HBVr ranged from 0% to 30.2%, with an overall rate of 6.2% (225/3601).…”

Role of virological serum markers in patients with both hepatitis B virus infection and diffuse large B‐cell lymphoma

“…Various studies have demonstrated that HBV infection might impair overall survival (OS) and progression-free survival (PFS) of patients with DLBCL compared to HBV negative individuals. [8][9][10] Within the patients with both DLBCL and chronic or resolved HBV infection with positive hepatitis B core antibody (anti-HBc), however, the impact of different virological serum markers of HBV infection such as hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), hepatitis B envelope antigen (HBeAg), hepatitis B envelope antibody (anti-HBe), and HBV-DNA on survival of patients are rarely reported and discussed. The implication of these virological markers in the clinical practice is still unclear.…”

“…However, the biological mechanism of DLBCL development in patients with HBV infection remains not fully understood, and the clinical implication of HBV infection in patients with DLBCL is also a matter of debate. Various studies have demonstrated that HBV infection might impair overall survival (OS) and progression‐free survival (PFS) of patients with DLBCL compared to HBV negative individuals 8,9,10. Within the patients with both DLBCL and chronic or resolved HBV infection with positive hepatitis B core antibody (anti‐HBc), however, the impact of different virological serum markers of HBV infection such as hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti‐HBs), hepatitis B envelope antigen (HBeAg), hepatitis B envelope antibody (anti‐HBe), and HBV‐DNA on survival of patients are rarely reported and discussed.…”