E-ISSN: 1308-5263
Splenic Marginal Zone Lymphoma in Turkey: Association with Hepatitis B Instead of Hepatitis C Virus as an Etiologic and Possible Prognostic Factor - A Multicenter Cohort Study [Turk J Hematol]
Turk J Hematol. 2020; 37(2): 84-90 | DOI: 10.4274/tjh.galenos.2019.2019.0177  

Splenic Marginal Zone Lymphoma in Turkey: Association with Hepatitis B Instead of Hepatitis C Virus as an Etiologic and Possible Prognostic Factor - A Multicenter Cohort Study

Müfide Okay1, Tuncay Aslan1, Evren Özdemir2, Ayşegül Üner3, Arzu Sağlam3, Elif Güngör4, Ayşe Uysal5, Nevin Alayvaz Aslan6, Esra Yıldızhan7, Abdullah Ağıt8, Mehmet Sinan Dal9, Serdal Korkmaz10, Sinem Namdaroğlu11, Serdar Sivgin12, Gülsüm Akgün Cağlıyan13
1Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
2Medicana International Ankara Hospital, Clinic of Medical Oncology, Ankara, Turkey
3Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, Turkey
4Trakya University Faculty of Medicine, Department of Internal Medicine, Edirne, Turkey
5University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Division of Hematology, Trabzon, Turkey
6Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
7Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
8Ankara Numune Training and Research Hospital, Division of Hematology, Ankara, Turkey
9University of Health Sciences, Ankara Oncology Training and Research Hospital, Clinic of Hematology and BMT Unit, Ankara, Turkey
10Kayseri Training and Research Hospital, Division of Hematology, Kayseri, Turkey
11University of Health Sciences, İzmir, Turkey
12Acıbadem Kayseri Hospital, Kayseri, Turkey
13Denizli State Hospital, Division of Hematology, Denizli, Turkey

Objective: Chronic antigenic stimulation is frequently blamed in the pathogenesis of extranodal marginal zone lymphomas including splenic marginal zone lymphoma (SMZL). Chronic hepatitis C is frequently observed in SMZL patients in some geographical regions. However, these reports are largely from North America and Europe, and data from other countries are insufficient. In this multicenter study we aimed to identify the clinical characteristics of SMZL patients in Turkey, including viral hepatitis status and treatment details.
Materials and Methods: Data were gathered from participating centers from different regions of Turkey using IBM SPSS Statistics 23 for Windows. Hepatitis B virus surface antigen (HBsAg), anti-HBs antibody, anti-HB core antigen antibody (anti-HBcAg), HB viral load, anti-hepatitis C virus (HCV) antibody, HCV viral load results were analyzed.
Results: One hundred and four patients were reported. Hepatitis C virus positivity was observed in only one patient. However, hepatitis B virus surface antigen (HBsAg) positivity was observed in 11.2% and HBsAg and/or anti-HB core antigen antibody (anti-HBcAg) positivities were seen in 34.2% of the patients. The median age was 60 years (range=35-87). Median follow-up duration was 21.2 months (range=00.2-212; 23.2 months for surviving patients). Median overall survival was not reached. Estimated 3-year and 10-year survival rates were 84.8% and 68.9%, respectively. Older age, no splenectomy during follow-up, platelet count of <90x103/µL, lower albumin, higher lactate dehydrogenase, higher β2-microglobulin, and HBsAg positivity were associated with increased risk of death. Only albumin remained significant in multivariable analysis.
Conclusion: These results indicate that hepatitis B virus may be a possible risk factor for SMZL in our population. It may also be an indirect prognostic factor.

Keywords: Low-grade lymphoma, Hepatitis B virus, Hepatitis C virus, Risk factors


Türkiye’de Splenik Marjinal Zon Lenfoma: Hepatit C Virüs Yerine Hepatit B Virüsünün Etiyolojik ve Olası Prognostik Faktör Oluşu-Çok Merkezli Kohort Çalışması

Müfide Okay1, Tuncay Aslan1, Evren Özdemir2, Ayşegül Üner3, Arzu Sağlam3, Elif Güngör4, Ayşe Uysal5, Nevin Alayvaz Aslan6, Esra Yıldızhan7, Abdullah Ağıt8, Mehmet Sinan Dal9, Serdal Korkmaz10, Sinem Namdaroğlu11, Serdar Sivgin12, Gülsüm Akgün Cağlıyan13
1Hacettepe University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey
2Medicana International Ankara Hospital, Clinic of Medical Oncology, Ankara, Turkey
3Hacettepe University Faculty of Medicine, Department of Pathology, Ankara, Turkey
4Trakya University Faculty of Medicine, Department of Internal Medicine, Edirne, Turkey
5University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Division of Hematology, Trabzon, Turkey
6Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, Turkey
7Erciyes University Faculty of Medicine, Department of Hematology, Kayseri, Turkey
8Ankara Numune Training and Research Hospital, Division of Hematology, Ankara, Turkey
9University of Health Sciences, Ankara Oncology Training and Research Hospital, Clinic of Hematology and BMT Unit, Ankara, Turkey
10Kayseri Training and Research Hospital, Division of Hematology, Kayseri, Turkey
11University of Health Sciences, İzmir, Turkey
12Acıbadem Kayseri Hospital, Kayseri, Turkey
13Denizli State Hospital, Division of Hematology, Denizli, Turkey

Amaç: Splenik marjinal zon lenfoma’yı da (SMZL) içeren ekstranodal marjinal zon lenfomaların patogenezinde, kronik antijenik stimülasyon sorumlu olan mekanizmadır. Bazı coğrafik bölgelerde SMZL hastalarında kronik hepatit C sıklıkla gözlenir. Fakat bu çalışmalar sıklıkla kuzey Amerika ve Avrupa’dandır. Diğer ülkelerden veriler sınırlıdır. Bu çalışma ile Türkiye’deki SMZL hastalarının hepatit serolojisi durumları ve tedavi yöntemlerinin ortaya konulması amaçlanmıştır
Gereç ve Yöntem: Türkiye’de farklı merkezlerden IBM SPSS Statistics for Windows v23 elektronik tablo kullanılarak veriler toplanmıştır. Hepatit B virüs yüzey antijeni (HBsAg), Anti-HBs antikor, Anti-HB kor antijen antikoru (anti-HBcAg), HB virüs yükü, anti-hepatit C virüs (HCV) antikoru, HCV virüs yükü sonuçları analiz edilmiştir.
Bulgular: Yüz dört hastanın verilerine ulaşılmıştır. Hepatit C virüs pozitifliği sadece 1 hastada tespit edilmiştir. Hepatit B virüs yüzey antijeni (HBsAg) pozitifliği %11,2, HBsAg ve/veya hepatit B kor antijen antikoru (anti-HBcAg) pozitifliği %34,2 oranında tespit edilmiştir. Ortanca yaş 60 yıl (35-87) olarak saptanmıştır. Ortanca izlem süresi 21,2 (0,2-212) ay (yaşayan hastalar için 23,2 ay) olarak bulunmuştur. Ortanca genel sağkalım (GS) süresine ulaşılamamıştır. Tahmini 3-yıl ve 10-yıl GS oranları %84,8 ve %68,9 olarak bulunmuştur. İleri yaş, splenektomi yapılmaması, <90x103/µL platelet sayısı, hipoalbuminemi, laktat dehidrogenaz yüksekliği, β2-mikroglobulin yüksekliği ve HBsAg pozitifliği sağkalımla ilişkili faktörler olarak bulunmuştur. Çok değişkenli analizde, sadece albumin düşüklüğü istatistiksel olarak anlamlı saptanmıştır.
Sonuç: Bu çalışmanın sonuçlarına göre, toplumumuzda SMZL için hepatit B virüsü olası bir risk faktörü olabilir. Aynı zamanda indirek bir prognostik gösterge olabilir.

Anahtar Kelimeler: Düşük dereceli lenfoma, Hepatit B virüs, Hepatit C virüs, Risk faktörleri


Müfide Okay, Tuncay Aslan, Evren Özdemir, Ayşegül Üner, Arzu Sağlam, Elif Güngör, Ayşe Uysal, Nevin Alayvaz Aslan, Esra Yıldızhan, Abdullah Ağıt, Mehmet Sinan Dal, Serdal Korkmaz, Sinem Namdaroğlu, Serdar Sivgin, Gülsüm Akgün Cağlıyan. Splenic Marginal Zone Lymphoma in Turkey: Association with Hepatitis B Instead of Hepatitis C Virus as an Etiologic and Possible Prognostic Factor - A Multicenter Cohort Study. Turk J Hematol. 2020; 37(2): 84-90

Corresponding Author: Müfide Okay


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