EVOLUŢIA PARTICULARĂ A SINDROAMELOR LIMFOPROLIFERATIVE CRONICE ASOCIATE CU INFECŢIA CU VIRUS HEPATITIC B ŞI REACTIVAREA VIRALĂ – O PROBLEMĂ IMPORTANTĂ CU ABORDARE MULTIDISCIPLINARĂ

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Background. The association of hepatitis B virus (HBV) infection with chronic lymphoproliferative disorders becomes a matter of debate, with multidisciplinary approach due to possible viral reactivation after immuno-chemotherapy. Material and methods. We studied two patient groups with chronic lymphoproliferative disorders, one with HBV infection (HbsAg+ and HbsAg- HbcAb+ HBs+/-) – 43 patients and one without viral infection (104 patients). Clinical and paraclinical parameters, therapy, survival of both groups were compared; the occurrence of viral reactivation was followed. Data were statistically analyzed. Results and discussion. The HBV infection group included HbsAg+-ve patients (72%) and occult HBV infection patients. The median onset age for lymphoproliferative disorders HBV+-ve was significantly younger (55 vs. 61 years, p<0.05). Hepatomegaly and abdominal adenopathies were more frequent in HBV patients (p=0.003, respectively p=0.027). Hepatic function was altered in HBV patients both at disease onset (AST p=0.0213, GGT p=0.0002) and after first line therapy (AST p=0.0003, ALT p=0.019, FA p=0.008, GGT p=0.000, total bilirubine p=0.043, INR p=0.0003 and albumine p=0.05). The risk of hepatic dysfunction after first line therapy is increased 6 times by HBV infection (p=0.0009, OR=6.000, 95%CI: 1.9121-18.8272), which could negatively impact the hematological disease evolution by lowering therapeutic dose, leading to an inferior treatment result. Viral reactivation occurred both in HbsAg+-ve (21.42%) and HbsAg- HbcAb+-ve patients (60%). None of the occult carriers received antiviral prophylaxis. Whithin our occult carrier group, the viral reactivation percentage is high, therefore we would reccomand antiviral prophylaxis. The overall survival was similar in both group of patients. Conclusions. HBV-positive chronic lymphoproliferative disorders could become a new pathological entity, with individual clinical features and outcome and possibly with negative impact on long term survival. Antiviral prophylaxis for occult carriers could significantly reduce the viral reactivation rate and therefore the therapeutic guidelines should be revised.