Inferior survival and frequent hepatic dysfunction in non-Hodgkin’s lymphoma patients with HBV infection: a systematic review and meta-analysis

Abstract

ABSTRACT Objectives No clear consensus has been reached about the clinical features in hepatitis B virus (HBV)-associated non-Hodgkin’s lymphoma (NHL) patients. We performed a systematic review and meta-analysis to explore the clinical characteristics and prognosis of NHL patients with chronic HBV infection (HBsAg+). Methods Seven electronic databases were searched for relevant studies up to 31 January 2021. Hazard ratio (HR) or odds ratio (OR) corresponding to 95% confidence interval (CI) were calculated to estimate the outcomes. The primary outcome was survival outcome, including overall survival (OS) and progression-free survival (PFS). Subgroup analysis was performed in diffuse large B-cell lymphoma (DLBCL) patients. Results Twenty-three retrospective studies, comprising of 1202 HBsAg+ NHL patients and 4448 HBsAg− NHL patients, were included. Twenty-two studies were conducted on Chinese patients. Compared with HBsAg− NHL patients, significantly shorter OS (HR 1.68; 95% CI 1.48–1.91) and PFS (HR 1.80; 95% CI 1.20–2.71), lower rate of complete remission (OR 0.59, 95% CI 0.44–0.80) and higher frequency of hepatic dysfunction during chemotherapy (OR 3.46; 95% CI 2.61–4.57) were demonstrated in HBsAg+ NHL patients. Moreover, HBsAg+ patients were characterized by a younger age of disease onset, advanced disease stage, higher level of LDH and more frequent presence of B symptoms, and involvement of spleen and liver at diagnosis. Furthermore, subgroup analysis in DLBCL patients was also showed similar results. Conclusion Our study implicated that NHL patients, especially DLBCL, with chronic HBV infection displayed inferior prognosis, higher incidence of hepatic dysfunction during chemotherapy and distinct clinical features.