1. Retrospective Study of the Incidence and Risk Factors for Hematological Malignancies in Patients with Hepatitis B Virus Infection
- Author
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Edwin P. Hui, Radha Raghupathy, Henny H. Billett, Ryan Cy Ho, Carmen Km Cheung, Uriel R. Felsen, Diwakar Mohan, Erin Jou, and Anthony T.C. Chan
- Subjects
Hepatitis B virus ,medicine.medical_specialty ,HBsAg ,education.field_of_study ,medicine.diagnostic_test ,HIV Positivity ,business.industry ,Immunology ,Population ,Cell Biology ,Hematology ,Hepatitis C ,Hepatitis B ,medicine.disease_cause ,medicine.disease ,Biochemistry ,Gastroenterology ,Liver biopsy ,Internal medicine ,medicine ,business ,education ,Viral load - Abstract
Background: Hepatitis B infection may be associated with an increased risk of non hodgkins lymphoma, especially diffuse large B cell lymphoma. Whether an intact immune system is required hepatitis B mediated lymphomagenesis and if factors such as other viral co infections and paraproteins may further compound this risk remains unclear. We retrospectively studied our large database of HBsAg positive patients for diagnoses of hematological malignancies or premalignant disorders (HM) and the risk factors for their development. Methods: Patients over the age of 18 with at least one positive HBsAg test between Jan 1st 2001 and Dec 31st 2011 were identified using the medical center database, clinical looking glass. Data were collected regarding demographics, HIV and hepatitis C status. Serum protein electrophoresis tests done after the HBsAg test were reviewed. Results of all biopsies performed for each patient, ICD9 and cancer registry diagnoses were reviewed for biopsy confirmed diagnoses of a HM. Liver biopsy results were reviewed for evidence of chronic hepatitis changes. Results: 3177 of 216,522 patients (1.5%) tested were HBsAg positive. Mean age of the HBsAg positive group was 43 years, 56% were male. 44% were black, 8% white and 7.4% were Asian. 33.6% of these patients had two positive HBsAg tests 6 months apart. 10.3% of patients underwent a liver biopsy and 9.4% of patients had biopsy changes consistent with chronic hepatitis. Of the 3177 patients, 4.9% (155 patients) had a biopsy of any lymphatic tissue or bone marrow performed. 2.2 % (71 patients) had a hematological malignancy or premalignant disorder diagnosed. 0.4% (12 patients) had an insufficient specimen for diagnosis and were excluded from further analysis. Of the 71 patients with a HM, 30 (42.3%) had a high grade B or T cell lymphoma; 12 (16.9%) had myeloma or smoldering myeloma; 11 (15.5%) had a low grade lymphoma; 6 (8.4%) had myelodysplasia, myeloproliferative disorder or acute leukemia and 11 (15.5%) had a premalignant disorder including multicentric castleman, MGUS or NK cell lymphocytosis. 47% of high grade lymphomas occurred in an extranodal location. Within the HBsAg positive population, HM positive patients (n=71) compared to HM negative controls (n=3094) were significantly older (52.5 vs 43 yrs, p
- Published
- 2014