Splenic Marginal Zone Lymphoma in Turkey: Association With Hepatitis B Instead Of Hepatitis C Virus As An Etiologic and Possible Prognostic Factor-Multicenter Cohort Study

Abstract

Objective: Chronic antigenic stimulation is frequently blamed in the pathogenesis of extranodal marginal zone lymphomas including splenic marginal zone lymphoma (SMZL). Chronic hepatitis C is frequently observed in SMZL patients in some geographical regions. However, these reports are largely from North America and Europe, and data from other countries are insufficient. In this multicenter study we aimed to identify the clinical characteristics of SMZL patients in Turkey, including viral hepatitis status and treatment details. Materials and Methods:Data were gathered from participating centers from different regions of Turkey using IBM SPSS Statistics 23 for Windows. Hepatitis B virus surface antigen (HBsAg), anti-HBs antibody, anti-HB core antigen antibody (anti-HBcAg), HB viral load, anti-hepatitis C virus (HCV) antibody, HCV viral load results were analyzed. Results:One hundred and four patients were reported. Hepatitis C virus positivity was observed in only one patient. However, hepatitis B virus surface antigen (HBsAg) positivity was observed in 11.2% and HBsAg and/or anti-HB core antigen antibody (anti-HBcAg) positivities were seen in 34.2% of the patients. The median age was 60 years (range=35-87). Median follow-up duration was 21.2 months (range=00.2-212; 23.2 months for surviving patients). Median overall survival was not reached. Estimated 3-year and 10-year survival rates were 84.8% and 68.9%, respectively. Older age, no splenectomy during follow-up, platelet count of <90x10 3 /µL, lower albumin, higher lactate dehydrogenase, higher β 2 -microglobulin, and HBsAg positivity were associated with increased risk of death. Only albumin remained significant in multivariable analysis. Conclusion:These results indicate that hepatitis B virus may be a possible risk factor for SMZL in our population. It may also be an indirect prognostic factor. Amaç: Splenik marjinal zon lenfoma'yı da (SMZL) içeren ekstranodal marjinal zon lenfomaların patogenezinde, kronik antijenik stimülasyon sorumlu olan mekanizmadır. Bazı coğrafik bölgelerde SMZL hastalarında kronik hepatit C sıklıkla gözlenir. Fakat bu çalışmalar sıklıkla kuzey Amerika ve Avrupa'dandır. Diğer ülkelerden veriler sınırlıdır. Bu çalışma ile Türkiye'deki SMZL hastalarının hepatit serolojisi durumları ve tedavi yöntemlerinin ortaya konulması amaçlanmıştır. Gereç ve Yöntemler: Türkiye'de farklı merkezlerden IBM SPSS Statistics for Windows v23 elektronik tablo kullanılarak veriler toplanmıştır. Hepatit B virüs yüzey antijeni (HBsAg), Anti-HBs antikor, Anti-HB kor antijen antikoru (anti-HBcAg), HB virüs yükü, anti-hepatit C virüs (HCV) antikoru, HCV virüs yükü sonuçları analiz edilmiştir.Bulgular: Yüz dört hastanın verilerine ulaşılmıştır. Hepatit C virüs pozitifliği sadece 1 hastada tespit edilmiştir. Hepatit B virüs yüzey antijeni (HBsAg) pozitifliği %11,2, HBsAg ve/veya hepatit B kor antijen antikoru (anti-HBcAg) pozitifliği %34,2 oranında tespit edilmiştir. Ortanca yaş 60 yıl (35-87) olarak saptanmıştır. Ortanca izlem süresi 21,2 (0,2-212) ay (yaşayan hastal...

Superior outcome for splenectomised patients in a population‐based study of splenic marginal zone lymphoma in Sweden

“…HCV is considered to be very widespread globally, 2,36,37 whereas in Sweden the prevalence is considered to be relatively low, which could explain why HCV infection was rare in our population. HBV was recently shown to be associated with SMZL, 6 but we could not confirm this association. Thus, HBV and HCV infections do not seem to be major contributors to the development of SMZL in populations with a low prevalence of these infections.…”

“…The cause of SMZL is unknown. However, associations with autoimmune and inflammatory diseases (AID) and infection with hepatitis C virus (HCV) or hepatitis B virus (HBV) 6 have led to theories of chronic inflammatory conditions being a contributory cause of SMZL 2 . Previous studies, mainly from southern Europe, have described an association between HCV infection and SMZL in up to 35% of cases 2,7–9 …”

Putative role of marginal zone B cells in pathophysiological processes

“…84 On the other hand, Chinese and Turkish patients had a significant association of this lymphoma type with hepatitis B virus (HBV) infection, suggesting the endemic HBV infection and genotypic predetermination as an aetiological factor in Asian population. 83,85,86 Possible involvement of HIV-1 87 and Mycobacterium shigaense 88 in SMZL development was speculated in some patients. Moreover, it is estimated that about 20% of all SMZL patients demonstrate some autoimmune manifestation.…”