Real-world clinical features and survival outcomes in diffuse large B-cell lymphoma patients with hepatitis B virus infection.

IF 3.1 2区医学 Q3 IMMUNOLOGY

Infectious Agents and Cancer Pub Date : 2024-10-25 DOI:10.1186/s13027-024-00617-z

Wanxi Yang, Xue Zhao, Hongbing Ma, Caigang Xu

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引用次数: 0

Abstract

Objective: Hepatitis B virus (HBV) infection is associated with the incidence and prognosis of diffuse large B-cell lymphoma (DLBCL), and previous studies differ in terms of clinical characteristics and prognostic factors. In this study, we explored the clinical features and prognostic characteristics of real-world DLBCL patients infected with HBV.

Methods: Patients with pathologically diagnosed primary DLBCL at West China Hospital of Sichuan University were enrolled. Patients with follicular lymphoma-transformed DLBCL, primary central nervous system DLBCL, and hepatitis C virus, hepatitis E virus, human immunodeficiency virus, or syphilis infections were excluded. Ultimately, a total of 941 patients were included in this study. All patients included in the study underwent HBV serum marker testing before treatment. The demographic features, clinical characteristics and treatments of patients with different HBV infection states were collected and analyzed comprehensively to identify prognostic factors for OS and PFS.

Results: Statistical analysis of the data revealed that hepatitis B surface antigen positive (HBsAg +) DLBCL patients were younger and more likely to present with advanced disease, germinal center B cell-like subtype, B symptoms and splenic involvement. There were no significant differences in OS or PFS among patients with different HBV infection statuses ( $χ$ ² = 0.139, P = 0.933; χ² = 0.787, P = 0.675); R-CHOP/R-CHOP-like regimens improved prognosis in HBsAg + DLBCL patients (OS: χ² = 7.679, P = 0.006; PFS: χ² = 9.042, P = 0.003); antiviral prophylaxis for HBsAg + DLBCL patients improved OS and PFS (HR: 0.336, P = 0.012, 95% CI [0.143, 0.788]; HR: 0.397, P = 0.032, 95% CI [0.171, 0.925]), with tenofovir treatment being particularly effective (χ² = 4.644, P = 0.031; χ² = 4.554, P = 0.033).

Conclusions: HBsAg + DLBCL patients have unique clinical characteristics, and the use of CD20 monoclonal antibody based regimens significantly improves the outcome and prognosis of patients with HBsAg + DLBCL. Anti-HBV therapy, especially tenofovir, improves the prognosis of DLBCL patients with HBV presenting infection. Timely and sustained antiviral prophylaxis should be the standard strategy for treating DLBCL patients with HBV infection to optimize the efficacy of chemotherapy and immunotherapy.

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弥漫大 B 细胞淋巴瘤患者合并乙型肝炎病毒感染的真实世界临床特征和生存结果。

目的：乙型肝炎病毒（HBV）感染与弥漫大B细胞淋巴瘤（DLBCL）的发病率和预后有关，以往的研究在临床特征和预后因素方面存在差异。在本研究中，我们探讨了现实世界中感染 HBV 的 DLBCL 患者的临床特征和预后特点：方法：纳入四川大学华西医院病理确诊的原发性 DLBCL 患者。排除滤泡性淋巴瘤转化的DLBCL患者、原发性中枢神经系统DLBCL患者以及丙型肝炎病毒、戊型肝炎病毒、人类免疫缺陷病毒或梅毒感染者。最终，本研究共纳入了 941 名患者。所有纳入研究的患者在治疗前均接受了 HBV 血清标志物检测。研究人员收集并综合分析了不同HBV感染状态患者的人口统计学特征、临床特征和治疗方法，以确定OS和PFS的预后因素：数据统计分析显示，乙肝表面抗原阳性（HBsAg +）的DLBCL患者更年轻，更有可能出现晚期疾病、生殖中心B细胞样亚型、B症状和脾脏受累。不同HBV感染状态患者的OS或PFS无明显差异（χ 2 = 0.139，P = 0.933；χ 2 = 0.787，P = 0.675）；R-CHOP/R-CHOP类方案可改善HBsAg + DLBCL患者的预后（OS：χ 2 = 7.679，P = 0.006；PFS：χ 2 = 9.042，P = 0.003）；HBsAg + DLBCL患者抗病毒预防可改善OS和PFS（HR：0.336，P = 0.012，95% CI [0.143，0.788]；HR：0.397，P = 0.032，95% CI [0.171，0.925]），其中替诺福韦治疗尤其有效（χ2 = 4.644，P = 0.031；χ2 = 4.554，P = 0.033）：HBsAg+DLBCL患者具有独特的临床特征，使用基于CD20单克隆抗体的治疗方案可显著改善HBsAg+DLBCL患者的疗效和预后。抗 HBV 治疗，尤其是替诺福韦，可改善存在 HBV 感染的 DLBCL 患者的预后。及时、持续的抗病毒预防应成为治疗HBV感染的DLBCL患者的标准策略，以优化化疗和免疫疗法的疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Agents and Cancer ONCOLOGY-IMMUNOLOGY

CiteScore

5.80

自引率

2.70%

发文量

期刊介绍： Infectious Agents and Cancer is an open access, peer-reviewed online journal that encompasses all aspects of basic, clinical, epidemiological and translational research providing an insight into the association between chronic infections and cancer. The journal welcomes submissions in the pathogen-related cancer areas and other related topics, in particular: • HPV and anogenital cancers, as well as head and neck cancers; • EBV and Burkitt lymphoma; • HCV/HBV and hepatocellular carcinoma as well as lymphoproliferative diseases; • HHV8 and Kaposi sarcoma; • HTLV and leukemia; • Cancers in Low- and Middle-income countries. The link between infection and cancer has become well established over the past 50 years, and infection-associated cancer contribute up to 16% of cancers in developed countries and 33% in less developed countries. Preventive vaccines have been developed for only two cancer-causing viruses, highlighting both the opportunity to prevent infection-associated cancers by vaccination and the gaps that remain before vaccines can be developed for other cancer-causing agents. These gaps are due to incomplete understanding of the basic biology, natural history, epidemiology of many of the pathogens that cause cancer, the mechanisms they exploit to cause cancer, and how to interrupt progression to cancer in human populations. Early diagnosis or identification of lesions at high risk of progression represent the current most critical research area of the field supported by recent advances in genomics and proteomics technologies.