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

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 (HCV), hepatitis E virus (HEV), human immunodeficiency virus (HIV), or syphilis (TP) 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, had more advanced disease at diagnosis, had a greater proportion of germinal center B cell-like lymphoma (GCB) type disease, and had more frequent B symptoms and splenic involvement. There were no significant differences in OS or PFS among patients with different HBV infection statuses χ2 = 0.139, P = 0.933; χ2 = 0.787, P = 0.675); HBsAg + DLBCL patients treated with the R-CHOP/R-CHOP-like regimen had better OS and PFS (χ2 = 7.679, P = 0.006; 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: 0.740, P = 0.032, 95% CI [0.171, 0.925]), and tenofovir improved OS and PFS (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 patients with DLBCL associated with HBV-presenting infection.