弥漫性大B细胞淋巴瘤中乙型肝炎病毒感染的并发和再激活：危险因素及生存结果
Concurrent and reactivation of hepatitis B virus infection in diffuse large B-cell lymphoma: risk factors and survival outcome.
作者信息
Guo Ya-Fei, Pan Jing-Xin, Zhuang Wei-Huang
机构信息
Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000 China.
出版信息
Infect Agent Cancer. 2018 Dec 12;13:40. doi: 10.1186/s13027-018-0215-4. eCollection 2018.
OBJECTIVE
To determine the clinical features and survival difference of HBV related and Non-HBV related diffuse large B-cell lymphoma (DLBCL) and to evaluate the occurrence of HBV reactivation in DLBCL patients and related risk factors for HBV reactivation after R-CHOP therapy.
METHODS
A total of 246 patients diagnosed with CD20+ DLBCL were enrolled from June 2010 to June 2015. The medical records and survival data were analysed. Multivariate logistic regression analysis was used to identify predictors of HBV reactivation. Survival curves were performed by the Kaplan-Meier method.
RESULTS
Among patients enrolled, 80 patients were HBsAg sero-positive and 166 patients were HBsAg sero-negative. Findings showed that HBsAg sero-negative patients were significantly older than that of patients with HBsAg sero-positive ( < 0.001). Proportion of B symptom positive patients in HBsAg sero-positive were higher ( = 0.002). Higher LDH level ( = 0.019) and late Ann Arbor stage ( = 0.010) were more often observed in patients with HBsAg sero-positive. The rate of complete response, partial response, stable disease and progress disease in HBsAg sero-negative group were 63.9, 16.9, 1.1 and 18.1%, respective, which is significantly higher than that in HBsAg sero-positive group (36.2, 18.8, 1.2 and 43.8%). Kaplan-Meier analysis showed that DLBCL patients with HBsAg sero-negative had better prognosis. In total, 17 patients showed HBV reactivation among 166 patients (10.2%) with HBsAg sero-negative after R-CHOP treatment, while a significant higher HBV reactivation 18.75% (9/48) in HBsAb negative group were observed, with 8.25% (8/97) patients in HBsAb level 10-100 U/mL group, and 0% patients in HBsAb level higher than 100 U/mL group. Multivariable analysis showed that serum HBsAb and serum HBcAb were independent risk factors for HBV reactivation in DLBCL patients.
CONCLUSION
Our data revealed that characteristics and prognosis were significantly different between HBV related DLBCL than non-HBV related DLBCL patients. DLBCL patients with resolved hepatitis B are at a higher risk of developing HBV reactivation after R-CHOP chemotherapy compared with HBsAg-negative/HBcAb negative patients.
目的
确定乙型肝炎病毒（HBV）相关和非HBV相关弥漫性大B细胞淋巴瘤（DLBCL）的临床特征和生存差异，并评估DLBCL患者HBV再激活的发生情况以及R-CHOP治疗后HBV再激活的相关危险因素。
方法
选取2010年6月至2015年6月期间诊断为CD20+ DLBCL的246例患者。分析其病历和生存数据。采用多因素逻辑回归分析确定HBV再激活的预测因素。采用Kaplan-Meier法绘制生存曲线。
结果
入选患者中，80例HBsAg血清学阳性，166例HBsAg血清学阴性。结果显示，HBsAg血清学阴性患者的年龄显著高于HBsAg血清学阳性患者（P<0.001）。HBsAg血清学阳性患者中B症状阳性患者的比例更高（P=0.002）。HBsAg血清学阳性患者中更常观察到较高的乳酸脱氢酶（LDH）水平（P=0.019）和较晚的Ann Arbor分期（P=0.010）。HBsAg血清学阴性组的完全缓解率、部分缓解率、病情稳定率和疾病进展率分别为63.9%、16.9%、1.1%和18.1%，显著高于HBsAg血清学阳性组（36.2%、18.8%、1.2%和43.8%）。Kaplan-Meier分析显示，HBsAg血清学阴性的DLBCL患者预后较好。在166例HBsAg血清学阴性患者中，共有17例（10.2%）在R-CHOP治疗后出现HBV再激活，而HBsAb阴性组的HBV再激活率显著更高，为18.75%（9/48），HBsAb水平为10-100 U/mL组为8.25%（8/97），HBsAb水平高于100 U/mL组为0%。多因素分析显示，血清HBsAb和血清HBcAb是DLBCL患者HBV再激活的独立危险因素。
结论
我们的数据显示，HBV相关DLBCL患者与非HBV相关DLBCL患者的特征和预后存在显著差异。与HBsAg阴性/HBcAb阴性患者相比，已解决乙型肝炎的DLBCL患者在R-CHOP化疗后发生HBV再激活的风险更高。
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