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      乙型肝炎病毒感染对复发难治性弥漫大B细胞淋巴瘤疗效及预后的影响 Translated title: Efficacy and prognostic analysis of relapsed/refractory diffuse large B-cell lymphoma patients with hepatitis B virus infection

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          Abstract

          目的

          研究乙型肝炎病毒(HBV)感染对复发难治性弥漫大B细胞淋巴瘤(DLBCL)的疗效及预后的影响。

          方法

          回顾性分析2004年1月至2016年11月81例复发难治性DLBCL患者,根据乙型肝炎表面抗原(HBsAg)的情况将患者分为HBsAg阳性和HBsAg阴性两组,比较两组患者的临床特征、疗效和预后。

          结果

          全部81例复发难治性DLBCL患者中,HBsAg阳性患者24例(29.6%),HBsAg阴性患者57例(70.4%)。相较于HBsAg阴性组,HBsAg阳性组年轻患者更多( P=0.005)、Ann Arbor分期以Ⅲ~Ⅳ期为主( P<0.001)、国际预后指数(IPI)3~5分居多( P=0.010)、常出现血红蛋白减低( P=0.015)、常存在两处及以上结外累及( P=0.038)、更倾向结外复发( P=0.002),总有效率低(29.2%对68.4%, χ 2=10.720, P=0.001),中位生存时间短[(11.3±2.9)个月对(30.0±7.6)个月, χ 2=28.175, P<0.001]。

          结论

          严格控制HBV感染对复发难治性DLBCL患者生存及预后具有显著影响。

          Translated abstract

          Objective

          To evaluate the clinical and prognostic significance of hepatitis B virus infection on patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL).

          Methods

          A retrospective analysis was performed in 81 relapsed/refractory DLBCL cases who were treated with salvage regimens from January 2004 to November 2016. The patients were divided into two group, HBsAg positive and HBsAg negative group, and assessed the clinical features and survival time of two groups.

          Results

          Twenty-four (29.6%) patients were HBsAg positive and 57(70.4%) were negative. HBsAg-positive DLBCL patients showed unique clinical features, including more younger patients ( P=0.005), more advanced Ann Arbor stage ( P<0.001), high-risk IPI ( P=0.010), more hypohemoglobin ( P=0.015), especially extra-nodal involvement ( P=0.038) and recurrence ( P=0.002). Overall response rate (29.2% vs 68.4%, χ 2=10.720, P=0.001) and median overall survival time [(11.3±2.9) months vs (30.0±7.6) months, χ 2=28.175, P<0.001] were inferior in HBsAg-positive patients, respectively.

          Conclusion

          To strictly control HBV infection plays an important role on the survival and prognosis of relapsed/refractory lymphoma patients.

          Related collections

          Most cited references21

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          Report of an international workshop to standardize response criteria for non-Hodgkin's lymphomas. NCI Sponsored International Working Group.

          Standardized guidelines for response assessment are needed to ensure comparability among clinical trials in non-Hodgkin's lymphomas (NHL). To achieve this, two meetings were convened among United States and international lymphoma experts representing medical hematology/oncology, radiology, radiation oncology, and pathology to review currently used response definitions and to develop a uniform set of criteria for assessing response in clinical trials. The criteria that were developed include anatomic definitions of response, with normal lymph node size after treatment of 1.5 cm in the longest transverse diameter by computer-assisted tomography scan. A designation of complete response/unconfirmed was adopted to include patients with a greater than 75% reduction in tumor size after therapy but with a residual mass, to include patients-especially those with large-cell NHL-who may not have residual disease. Single-photon emission computed tomography gallium scans are encouraged as a valuable adjunct to assessment of patients with large-cell NHL, but such scans require appropriate expertise. Flow cytometric, cytogenetic, and molecular studies are not currently included in response definitions. Response rates may be the most important objective in phase II trials where the activity of a new agent is important and may provide support for approval by regulatory agencies. However, the goals of most phase III trials are to identify therapies that will prolong the progression-free survival, if not the overall survival, of the treated patients. We hope that these guidelines will serve to improve communication among investigators and comparability among clinical trials until clinically relevant laboratory and imaging studies are identified and become more widely available.
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            Diffuse large B-cell lymphoma: optimizing outcome in the context of clinical and biologic heterogeneity.

            Although the majority of patients with diffuse large B-cell lymphoma (DLBCL) can be cured with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), patients who fail R-CHOP have a dismal outcome. Thus, optimization of front-line therapy, as well as the development of more effective salvage strategies, remains an important objective. Advances in molecular genetics have vastly improved our understanding of the biological diversity of DLBCL and have led to the discovery of key oncogenic pathways. In addition to the major molecular designations of germinal center B-cell and activated B-cell subtypes, next-generation sequencing technologies have unveiled the remarkable complexity of DLBCL and identified unique molecular targets that may be differentially exploited for therapeutic benefit. These findings have translated into a growing list of promising novel agents. Moving forward, it is of paramount importance to recognize the heterogeneity of DLBCL and to investigate these targeted agents within patient populations who are most likely to benefit. It will be necessary to prioritize drugs that affect key driver pathways and to combine them rationally to optimize their benefit. Improved prognostication and the availability of predictive biomarkers will be crucial to allow for the possibility of individualized risk-adapted therapy.
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              Seroepidemiology of hepatitis B virus infection in 2 million men aged 21-49 years in rural China: a population-based, cross-sectional study.

              Hepatitis B virus (HBV) infection is highly endemic (7-8% prevalence) in rural China, causing high mortality and societal burden. Data from men of reproductive age is scarce and last reported in 2006. We assessed the seroepidemiology of men in rural China, aiming to provide updated baseline data for the prevalence of HBV infection.
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                Author and article information

                Journal
                Zhonghua Xue Ye Xue Za Zhi
                Zhonghua Xue Ye Xue Za Zhi
                CJH
                Chinese Journal of Hematology
                Editorial office of Chinese Journal of Hematology (No. 288, Nanjing road, Heping district, Tianjin )
                0253-2727
                2707-9740
                December 2018
                : 39
                : 12
                : 1017-1020
                Affiliations
                [1]200025 上海交通大学医学院附属瑞金医院,医学基因组学国家重点实验室,上海血液学研究所State Key Laboratory of Medical Genomics; Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai 200025, China
                Author notes
                通信作者:赵维莅(Zhao Weili),Email: zhao.weili@ 123456yahoo.com
                Article
                cjh-39-12-1017
                10.3760/cma.j.issn.0253-2727.2018.12.009
                7348225
                30612404
                d5d09c8a-e5cc-425f-adda-532400b81fcc
                2018年版权归中华医学会所有Copyright © 2018 by Chinese Medical Association

                This work is licensed under a Creative Commons Attribution 3.0 License (CC-BY-NC). The Copyright own by Publisher. Without authorization, shall not reprint, except this publication article, shall not use this publication format design. Unless otherwise stated, all articles published in this journal do not represent the views of the Chinese Medical Association or the editorial board of this journal.

                History
                : 4 April 2018
                Funding
                基金项目:上海市教育委员会高峰高原学科建设计划(20152206、20152208);上海市科学技术委员会项目(14430723400、14140903100、16JC1405800);国家自然科学基金(81325003、81520108003、81670716、81201863)
                Fund program: Shanghai Municipal Education Commission- Gaofeng Clinical Medicine Grant Support (20152206, 20152208); Project of Shanghai Municipal Science and Technology Commission (14430723400, 14140903100, 16JC1405800); National Natural Science Foundation of China (81325003, 81520108003, 81670716, 81201863)
                Categories
                论著

                弥漫大b细胞淋巴瘤,乙型肝炎病毒,复发,难治,lymphoma, large b-cell, diffuse,hepatitis b virus,recurrence,refractory

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