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Hepatitis B Virus Infection Linked to Non-Hodgkin Lymphoma in South Korean Study

SUMMARY: People with chronic hepatitis B virus (HBV) infection were almost twice as likely as uninfected individuals to develop non-Hodgkin lymphoma and certain other types of blood cell cancers, according to a large South Korean analysis described in the August 4, 2010 advance online edition of Lancet Oncology. Occurrence of lymphoma was uncommon overall, however, indicating that prevention and treatment of hepatitis B is unlikely to greatly affect lymphoma rates.

By Liz Highleyman

Eric Engels from the U.S. National Cancer Institute and colleagues from South Korea performed a study to assess whether chronic hepatitis B increased the risk of subsequent development of NHL among patients in South Korea. HBV prevalence has historically been high in Korea -- as it is throughout Asia -- though lower today due to successful vaccination campaigns.

The researchers looked at participants in the Korean Cancer Prevention Study, a cohort of South Korean workers and their dependants enrolled during 1992-1995. They excluded individuals who died before January 1, 1993, those who had cancer at or before the initial study visit, those with a history of heavy alcohol use, people with HIV or hepatitis C virus (HCV) coinfection, and those missing information about height, weight, or alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels.

Out of 1,284,586 eligible participants, a total of 603,585 had available baseline data on hepatitis B surface antigen (HBsAg) status and were included in the analysis. People who tested positive for HBsAg at baseline were considered to have chronic HBV infection.

Follow-up continued for up to 14 years, through December 31, 2006. The study authors used national databases of inpatient and outpatient diagnoses and death records to determine occurrence of blood-related malignancies. They assessed the incidence (new cases) of NHL overall and of NHL subtypes, malignant immunoproliferation, Hodgkin's lymphoma, multiple myeloma, and various types of leukemia.


Out of the 603,585 eligible participants, 53,045 (8.8%) tested HBsAg positive at baseline.
Subsequently, 133 HBsAg positive participants and 905 HBsAg negative individuals developed NHL, for incidence rates of 19.4 vs 12.3 per 100,000 person-years, respectively.
HBsAg positive participants had an increased risk of NHL overall compared with HBsAg negative people after adjusting for sex, age, and year of study enrollment (adjusted hazard ratio [HR] 1.74, or nearly twice the risk).
Looking at NHL subtypes, HBsAg positivity was associated with increased risk of diffuse large B-cell lymphoma (325 cases, incidence rates 6.9 vs 3.8 per 100,000 person-years; adjusted HR 2.01), as well as malignancies of unknown subtype.
HBsAg positive participants also had an increased risk of malignant immunoproliferation (14 cases, incidence rates 0.4 vs 0.2 per 100,000 person-years; adjusted HR 3.79).
Risk for these malignancies was consistently higher among HBsAg positive participants throughout 14 years of follow-up.
Being HBsAg positive was not, however, associated with follicular or T-cell NHL, Hodgkin's lymphoma, multiple myeloma, or various leukemias.

Based on these findings, the study authors concluded, "During extended follow-up, HBsAg positive individuals had an increased risk of NHL, suggesting that chronic HBV infection promotes lymphomagenesis."

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; Institute of Human Genomic Study, College of Medicine, Korea University, Seoul, South Korea; Department of Epidemiology, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea


EA Engels, ER Cho, and SH Jee. Hepatitis B virus infection and risk of non-Hodgkin lymphoma in South Korea: a cohort study. Lancet Oncology (Abstract). August 4, 2010 (Epub ahead of print).
























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