Could Hepatitis B Infection Be a Predisposition For MCL?

A retrospective analysis of 10 years of patients with mantle cell lymphoma (MCL) from Peru showed a dismal survival rate, but also may have revealed a predisposition for this rare cancer, according to a presentation at the annual meeting of the Society of Hematologic Oncology in Houston.

Coauthor and presenter Melanie Castro-Mollo, MD, and colleagues from the Instituto Nacional de Enfermedades Neoplásicas in Lima reported that the patient cohort had a median overall survival (OS) of 27 months and that only about one in four were still alive after five years. Notably, the researchers also found that over one-third of the patients had hepatitis B at diagnosis, indicating a potential predisposition for MCL.

They analyzed MCL clinical features and outcomes in 167 newly diagnosed Peruvian patients who were treated at their institution from 2010 to 2019. Of these patients, 86% were in Ann Arbor Stage III-IV, 32% were unable to work or were bedridden, and 63.9% had bone marrow involvement. Hepatitis B-positive serology was detected in 61 patients (36.5%).

Furthermore, 36% of patients had extranodal involvement, including in the gastrointestinal tract (21 patients), Waldeyer’s ring (nine patients), and spleen (seven patients). Based on the Mantle Cell Lymphoma Prognostic Index (MIPI), 7.2% were categorized as low-risk, 23.7% were deemed to be intermediate-risk, and 69.1% were classified as high-risk.

Chemotherapy was given to 131 patients; 66.9% received R-CHOP as a first-line treatment and 12.9% received R-CVP. In addition, 7.3% underwent CHOEP and 6.5% were administered R-CHOP/R-DHAP.

Only 42 patients had complete response, while 28 had partial response and 20 had progressive disease. Treatment response was not evaluable in 42 cases, according to the researchers.

Of the 40 patients who received second-line therapy, 18 were given R-ESHAP. Autologous stem cell transplants were provided as consolidation therapy in 10 patients, including three in the first complete response, according to the authors. Also, 31 received rituximab as maintenance therapy.

The patient cohort had median OS of 27 months and a five-year OS of 24.5%.

“Our 10-year Peruvian cohort reflects the aggressive clinical course of MCL, with dismal overall survival compared to the literature reported,” the authors concluded. “A third of patients present with hepatitis B virus infection at diagnosis, higher than in hyperendemic areas in Peru, suggesting hepatitis B infection might be a predisposition for MCL, which needs further investigation.”

Reference

Castro-Mollo M, Quintana S, Lopez L, et al. Clinical features and primary treatment outcomes for mantle cell lymphoma: Peruvian National Cancer Institute. Abstract MCL-639.  Presented at the Eleventh Annual Meeting of the Society of Hematologic Oncology; September 6-9, 2023; Houston, Texas.