The Study On The Relationship Of Multiple Myeloma And HBV Inefction

Backgrond: In recent years increasing studies has accumulated on the associationbetween the lymphoproliferative disorders and virus infection. A medical history of infectionwith some viruses or bacteria belongs to the well-established risk factors for lymphomas, andmay have a association with the lymphomagenesis. Hepatitis B virus and hepatitis C virusare hepatotropic as well as lymphotropic viruses, and can be responsible for clonalproliferation of lymphocytes. They may contribute to lymphomagenesis most notably inB-cell non-Hodgkin’s lymphoma. But it hasn’t drawed firm conclusions pertaining to theassociation of HBV and HCV with specific lymphoma subtypes so far. Multiple myeloma isa common form of B-cell tumor of lymphoid hematopoietic system, and occurs most in theelderly, and has the second highest incidence in hematological malignancies in our country.Recently some epidemiological cohort studies and case-control studies indicate to anassociation of HBV infection with multiple myeloma, and some researchers add multiplemyeloma to the list of potentially virus-associated lymphoma entities. In addition, someonehas found a correlationship between HBV positivity and chromosomal aberrations withinMM patients. But there is few studies on this topic, and because of regional differences indisease prevalence between them，the results are conflicting. So whether there is a causalrelationship between HBV infection and myeloma is still controversial. Our country has ahigh prevalence of hepatitis B virus infection. With the aging of society and because of thechanges in the environmental factors, MM has a trend of increasing incidence and earlier ageof onset in our country.The myeloma patients who have HBV infection become a group thatcan not be ignored. Therefore, it has important clinical significance to investigate whetherthere is a potential correlationship between multiple myeloma and HBV infection and therole that HBV infection plays in myeloma treatment and prognosis.Purpose: The aim of the present study was to verify the infection of hapatitis B virus inmultiple myeloma, the clinical features of multiple myeloma patients combined with HBVinfection, and the impact of HBV infection on the treatment.Methods: We retrospectively analyzed the clinical data of457cases of multiplemyeloma patients diagnosed from2008.01.01to2013.01.30in affiliated hospitals of JilinUniversity, and313cases are enrolled in. We collected the clinical and laboratoryexamination datas such as type, stage, the expression of hepatitis serological markers, HBV-DNA load, liver function before and after therapy and so on. We selected370age andsex-matched patients randomly as a control from the patients who were treated at affiliatedhospitals of Jilin University at the same time and hadn’t hematological diseases. We usedSPSS19.0statistical software package to sort and analyze the data. Patients’s clinical andlaboratory parameters were evaluated by χ2test or Fisher’s exact test for categoricalvariables, and by the t-test for numerical variables, and by the Cox logistic regressionanalysis for multivariate analysis clinical features. A two tailed P-value of less than0.05wasconsidered statistically significant.Results:(1)In313evaluable cases of multiple myeloma,27patients was HBsAgpositive, the rate of HBsAg positive (8.6%) had no significant difference with the prevalenceof the population (7.18%) reported in2006from the hepatitis B epidemiology survey. Thereis also no statistically significant difference compared with the control group.(2) In the casegroup29cases(9.3%) were “HBsAg negative and the HBsAb, HBeAb, HBcAbpositive”(three antibody positive), two of whom had a HBV-DNA load more than1×103copies/mL. There is no statistically significant difference between the case group and thecontrol group(43/370,11.6%).(3) The proportion of patients who were “HBsAg negative andHBsAb positive combining with HBeAb or HBcAb positive” was higher in the MM group(14.7%,46/313vs10.3%,38/370in the control group), but it did not achieved statisticallysignificance (P=0.079).(4) There were68(21.7%) patients in the case group and35(9.5%)patients in the control group with “HBsAg and HBsAb negative combining with HBeAband/or HBcAb positive”. There is statistically significant difference between the two group.(5) According to the expression of HBsAg, the patients of case group were divided into twosubgroups. The HBsAg positive subgroup and HBsAg-negative subgroup had no significantdifference in gender, age, immunophenotyping, DS stage and ISS stage. The HBsAg positivesubgroup had a higher prevalance (16.0%) of hepatic damage before the treatment thanHBsAg-negative subgroup (6.7%), but it did not achieved statistically significance (P=0.105). The incidence of hepatic damage after treatment in the HBsAg-positive subgroup(52.0%) was higher than the HBsAg-negative subgroup (21.3%) with statisticallysignificance (P=0.001). In the HBsAg positive subgroup，13patients had hepatic damageafter treatment, of whom nine cases (69.2%) received hormonal-regimens-containingtreatment. Hepatic damage focused onⅠand Ⅱ degree.(6) During the25HBsAg positivepatients who received treatment for MM, eight cases received prophylactic antiviraltreatment, and one (12.5%) had HBV reactivation.14HBV-DNA negative patients had no receive antiviral therapy, and3cases (21.4%) had HBV reactivation. Two HBsAg-negativepatients had HBV reactivation.Conclusion: The prevalence of HBV infection in patients with MM was slightly higherthan in the Chinese population. Hepatic damage before treatment was much more commonin HbsAg positive patients than in HbsAg negative patients. HBsAg positive patients aremore prone to get liver damage during chemotherapy and treatment with immunomodulatoryagents. Hepatic damage focused onⅠand Ⅱ degree. Prophylactic antiviral therapy forHBsAg positive is recommend. Ractivation may also occur in occult HBV infection duringtreatment.