Clinical Characteristics And Prognostic Analysis Of HBV Infection Patients With B-cell Non-hodgkin's Lymphoma

Objective Lymphoma is a group of hematological malignancies originating from lymph nodes or lymphoid tissues.It is divided into two types: Hodgkin's lymphoma(HL)and non-Hodgkin's lymphoma(NHL).The etiology is not clear now.In recent years,It has been found that some of the infectious factors are closely related with the occurrence and development of lymphoma,such as EB virus,human T cell leukemia virus and Helicobacter pylori,but the relationship between hepatitis B virus infection and NHL has been controversial.Some studies found the incidence that NHL in patients with HBV infection was 2-3 times higher than that of non HBV infected patients.But further research is rather scarce,result in little knowledge about the clinical characteristics of HBV infection in patients with lymphoma,pathogenesis,prognosis et al.Meanwhile,previous literature reported that the application of rituximab can lead to HBV reactivation of such patients,therefore,wether HBV infection in patients with lymphoma need a special treatment program and the safety of rituximab could be considered again.The current article mainly discusses the assoiation between hepatitis B virus infection and B cell type non-Hodgkin's lymphoma(B cell Non-Hodgkin's Lymphoma,B-NHL),the clinical characteristics,prognosis,we also discuss the relationship between rituximab and prognosis in patients with HBV-infected B-NHL by retrospective clinical study.Methods A total of 345 B-NHL patients were recruited from three first class hospital in Qingdao,of which 65 were HBsAg-positive and 280 were HBsAg-negative.We compared the HBsAg-positive rate of 345 B-NHL patients with the general population and studied the clinical characteristics,overall survival(OS)rates and prognostic factors for the HBsAg-positive group.Meanwhile,HBsAg positive group was divided into R-CHOP and CHOP subgroups according to the treatment regimen,and survival analysis was performed between the two subgroups.Results The HBsAg-positive rate of 345 B-NHL patients was higher than the general population,which was` statistically significant(18.9% vs.7.2%,P<0.001).Compared with HBsAg negative group,HBsAg positive patients displayed a younger median onset age(48 years old,vs 58,P < 0.01),more frequent involvement of the liver,spleen or retroperitoneal lymph nodes(4.3% vs 12.3%,P=0.013;18.9% vs 33.8%,P=0.009;35.4% vs 56.9%,P=0.001),late stage of disease(III/IV),(44.6% vs 66.2%,P=0.002),and signifcantly worse outcome(2 year overall survival 49.2% vs 71.3%,P < 0.001).Univariate analysis showed that the poor prognostic factors for HBsAg positive patients were B symptoms,Ann Arbor stage(III/IV),?2-microglobulin,not combined with rituximab,not combined with radiotherapy.Multivariate analysis showed that B symptoms,Ann Arbor stage(III/IV),and not combined with rituximab were associated with poor prognosis.The total 65 HBsAg positive B-NHL patients have no one developed fulminant hepatitis,no reactivation of HBV related mortality,in which 35 cases were treated with R-CHOP and 30 cases were treated with CHOP.Rituximab combined with chemotherapy in tne HBsAg positive B-NHL patients can improve the overall survival and progression free survival time compared with patients who were treated with CHOP.There were 4 cases whose HBsAg turned to positive,and who were all treated with R-CHOP chemotherapy of the total 280 HBsAg negative B-NHL patients Conclusion The HBsAg-positive rate of B-NHL patients was significantly higher than that of the general population.HBsAg-positive B-NHL has its unique clinical features,and the prognosis is relatively poor,and the use of rituximab can improve the overall survival of HBsAg positive group.