Risk of hepatitis B virus reactivation in the treatment of HBsAg and HBV DNA double-negative lymphoma patients.
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BACKGROUND: It is well-known that lymphoma patients undergoing treatment are at risk of hepatitis B virus (HBV) reactivation. This study aims to explore the risk factors for HBV reactivation in lymphoma patients who tested negative for both hepatitis B surface antigen (HBsAg) and HBV DNA before treatment, during their course of therapy. It provides clinical evidence for early intervention in HBV reactivation and rational preventive antiviral treatment. METHODS: From January 2019 to December 2021, a total of 1,229 patients were diagnosed with lymphoma at Guangdong Provincial People's Hospital. Among them, 616 patients who tested negative for both HBsAg and HBV DNA and underwent therapy were recruited for the study. The recruited patients had a median age of 53.9 years (range: 14-88 years), with 358 males (58.12%) and 258 females (41.88%). The risk factors associated with HBV reactivation in these patients were then analyzed. RESULTS: Among the 616 lymphoma patients enrolled in this study, 44 patients (7.14%, 44/616) exhibited HBV reactivation. Notably, the rate of HBV reactivation was significantly higher in patients with hepatitis B core antibody (HBcAb) (+) (10.00%) compared to those with HBcAb (-) (1.46%) (P < 0.001, OR = 7.52). An analysis of HBV reactivation rates across different age groups demonstrated a statistically significant difference (P = 0.002). In particular, patients aged over 60 years showed a markedly elevated rate of HBV reactivation compared to those in other age brackets (P < 0.001). Conversely, no statistically significant differences in HBV reactivation rates were observed between patients of different genders (P = 0.637, OR = 0.855) or across varying treatment durations (P = 0.851). CONCLUSION: For lymphoma patients undergoing treatment, HBV reactivation may occur even if both HBsAg and HBV DNA are negative at the initiation of treatment. It is noteworthy that this study found that patients with HBcAb (-) also experienced HBV reactivation. Therefore, patients who are negative for HBsAg, HBcAb, and HBV DNA should also be closely monitored to mitigate the risk of HBV reactivation.