Treated chronic hepatitis B is a good prognostic factor of diffuse large B-cell lymphoma

Abstract

Background/Aims: Chronic hepatitis B (CHB) is a risk factor for non-Hodgkin lymphoma (NHL). Our recent study suggested that antiviral treatment may reduce the incidence of NHL in CHB patients. This study compared the prognoses of hepatitis B virus (HBV)-associated diffuse large B-cell lymphoma (DLBCL) patients receiving antiviral treatment and HBV-unassociated DLBCL patients.Methods: This study comprised 928 DLBCL patients who were treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) at two referral centers in Korea. All patients with CHB received antiviral treatment. Time-to-progression (TTP) and overall survival (OS) were the primary and secondary endpoints, respectively.Results: Among the 928 patients in this study, 82 were hepatitis B surface antigen (HBsAg)-positive (the CHB group) and 846 were HBsAg-negative (the non-CHB group). The median follow-up time was 50.5 months (interquartile range [IQR]=25.6–69.7 months). Multivariable analyses showed longer TTP in the CHB group than the non-CHB group both before inverse probability of treatment weighting (IPTW; adjusted hazard ratio [aHR]=0.49, 95% confidence interval [CI]=0.29–0.82, <i>p</i>=0.007) and after IPTW (aHR=0.42, 95% CI=0.26–0.70, <i>p</i><0.001). The CHB group also had a longer OS than the non-CHB group both before IPTW (HR=0.55, 95% CI=0.33–0.92, log-rank <i>p</i>=0.02) and after IPTW (HR=0.53, 95% CI=0.32–0.99, log-rank <i>p</i>=0.02). Although liver-related deaths did not occur in the non-CHB group, two deaths occurred in the CHB group due to hepatocellular carcinoma and acute liver failure, respectively.Conclusions: Our findings indicate that HBV-associated DLBCL patients receiving antiviral treatment have significantly longer TTP and OS after R-CHOP treatment than HBV-unassociated DLBCL patients.

Letter regarding “Treated chronic hepatitis B is a good prognostic factor of diffuse large B-cell lymphoma”

“…Lemaitre et al [ 2 ] found that when DLBCL is treated with R-CHOP and antivirals, patients (n=24) with HBV infection have similar outcomes to the non-HBV-infected patients. In addition, the median age of the patients with HBV-NHL was 59 years [ 2 ], which is close to that shown by Park et al [ 1 ] (56 years). These two studies suggest that treating HBV might be beneficial for most patients with DLBCL, whether they are in prevalent or non-prevalent areas.…”

“…In conclusion, we appreciate the valuable work by Park et al [ 1 ], which provided new insight into the treatment of patients with HBV-associated DLBCL. If it is possible to broaden the scope to include wider age ranges and non-endemic areas, we can gain a more comprehensive understanding of the treatment’s efficacy and ensure that it caters to a wider population.…”

“…We read with great interest the recent retrospective cohort study by Park et al [ 1 ], entitled “Treated chronic hepatitis B is a good prognostic factor of diffuse large B-cell lymphoma.” In the study, the authors compared the prognostic outcomes of two diffuse large B-cell lymphoma (DLBCL) groups from Seoul University Hospital and Seoul National University Hospital: patients with chronic hepatitis B virus (HBV) infection who received antiviral treatment and patients without HBV infection who did not receive antiviral treatment. The main finding of the article was that the time to progression, progression-free survival, and overall survival were significantly increased for the HBV-infected patients who received antiviral treatment.…”

“…First, we would like to compare this study [ 1 ] with another by Lemaitre et al [ 2 ] that investigated the characteristics and outcomes of HBV non-Hodgkin lymphoma (HBV-NHL) in HBV non-endemic countries. Lemaitre et al [ 2 ] found that when DLBCL is treated with R-CHOP and antivirals, patients (n=24) with HBV infection have similar outcomes to the non-HBV-infected patients.…”