Hepatitis B virus reactivation and hepatitis in diffuse large B-cell lymphoma patients with resolved hepatitis B receiving rituximab-containing chemotherapy: risk factors and survival.
Hepatitis B virus reactivation and hepatitis in diffuse large B-cell lymphoma patients with resolved hepatitis B receiving rituximab-containing chemotherapy: risk factors and survival.
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DOI：
10.1186/s40880-015-0015-9
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发表时间：
2015-05-28
影响因子：
--
通讯作者：
Cai QQ
中科院分区：
文献类型：
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作者：
Chen KL;Chen J;Rao HL;Guo Y;Huang HQ;Zhang L;Shao JY;Lin TY;Jiang WQ;Zou DH;Hu LY;Wirian ML;Cai QQ
在B型肝炎消退的B细胞淋巴瘤患者（B型肝炎表面抗原[HBsAg]阴性和B型肝炎核心抗体[HBcAb]阳性）中报告了B型肝炎病毒（HBV）再活化。本研究旨在评估接受含利妥昔单抗化疗的弥漫性大B细胞淋巴瘤（DLBCL）伴B型肝炎消退患者与HBsAg阴性/HBcAb阴性患者的HBV再激活和肝炎发生率，以确定HBV再激活和肝炎发生的风险因素，并分析HBV再激活和肝炎是否影响伴B型肝炎消退的DLBCL患者的生存率。我们回顾了2004年1月至2008年5月在中山大学肿瘤防治中心接受含利妥昔单抗治疗的278例DLBCL患者的临床资料。通过卡方检验或Fisher精确检验进行单变量分析，并通过考克斯回归模型进行多变量分析，对HBV再激活、肝炎发展和生存率的预测因素进行检验。278例患者中，165例HBsAg阴性。在这165例患者中，55例HBcAb阳性（HBV感染消退）患者中有6例（10.9%）发生HBV再激活，而110例HBcAb阴性患者中无一例（0%）发生HBV再激活（P = 0.001）。B型肝炎消退患者的肝炎发生率高于HBsAg阴性/HBcAb阴性患者（21.8% vs. 8.2%，P = 0.013）。HBcAb阳性和基线丙氨酸氨基转移酶（ALT）水平升高是肝炎的独立危险因素。在55例缓解的B型肝炎患者中，基线血清ALT或天冬氨酸转氨酶（AST）水平升高的患者比血清ALT或AST水平正常的患者更容易发生肝炎（分别为P = 0.037，P = 0.005）。基线AST水平升高是这些患者肝炎的独立风险因素。6例HBV再激活患者在立即抗病毒治疗后恢复，并继续化疗。HBcAb阳性、HBV再激活或肝炎对DLBCL患者的生存率没有负面影响。与HBsAg阴性/HBcAb阴性患者相比，B型肝炎消退的DLBCL患者发生HBV再激活和肝炎的风险可能更高。这些患者需要密切监测和及时的抗病毒治疗。
Hepatitis B virus (HBV) reactivation has been reported in B-cell lymphoma patients with resolved hepatitis B (hepatitis B surface antigen [HBsAg]-negative and hepatitis B core antibody [HBcAb]-positive). This study aimed to assess HBV reactivation and hepatitis occurrence in diffuse large B-cell lymphoma (DLBCL) patients with resolved hepatitis B receiving rituximab-containing chemotherapy compared with HBsAg-negative/HBcAb-negative patients to identify risk factors for HBV reactivation and hepatitis occurrence and to analyze whether HBV reactivation and hepatitis affect the survival of DLBCL patients with resolved hepatitis B. We reviewed the clinical data of 278 patients with DLBCL treated with rituximab-containing therapy between January 2004 and May 2008 at Sun Yat-sen University Cancer Center, China. Predictive factors for HBV reactivation, hepatitis development, and survival were examined by univariate analysis using the chi-square or Fisher’s exact test and by multivariate analysis using the Cox regression model. Among the 278 patients, 165 were HBsAg-negative. Among these 165 patients, 6 (10.9%) of 55 HBcAb-positive (resolved HBV infection) patients experienced HBV reactivation compared with none (0%) of 110 HBcAb-negative patients (P = 0.001). Patients with resolved hepatitis B had a higher hepatitis occurrence rate than HBsAg-negative/HBcAb-negative patients (21.8% vs. 8.2%, P = 0.013). HBcAb positivity and elevated baseline alanine aminotransferase (ALT) levels were independent risk factors for hepatitis. Among the 55 patients with resolved hepatitis B, patients with elevated baseline serum ALT or aspartate aminotransferase (AST) levels were more likely to develop hepatitis than those with normal serum ALT or AST levels (P = 0.037, P = 0.005, respectively). An elevated baseline AST level was an independent risk factor for hepatitis in these patients. Six patients with HBV reactivation recovered after immediate antiviral therapy, and chemotherapy was continued. HBcAb positivity, HBV reactivation, or hepatitis did not negatively affect the survival of DLBCL patients. DLBCL patients with resolved hepatitis B may have a higher risk of developing HBV reactivation and hepatitis than HBsAg-negative/HBcAb-negative patients. Close monitoring and prompt antiviral therapy are required in these patients.