RETROSPECTIVE STUDY OF PARAPROTEINEMIA PREVALENCE AND DEVELOPMENT OF HEMATOLOGICAL MALIGNANCIES IN HBSAG POSITIVE VERSUS HBSAG NEGATIVE PATIENTS
(Abstract release date: 05/19/16)
EHA Library. Raghupathy R. 06/09/16; 132800; E1251
Dr. Radha Raghupathy
Contributions
Contributions
Abstract
Abstract: E1251
Type: Eposter Presentation
Background
Hepatitis B virus is lymphotropic and persists in peripheral blood mononuclear cells for years after active infection. In chronic infection, persistent antigenic stimulation of lymphocytes occurs. Whether these effects of the virus on B cells increase the risk of paraproteinemia and its progression is unknown.
Aims
We proposed to compare HBsAg+ versus HBsAg negative patients identified in the same time frame for prevalence of paraproteins and risk of development of hematological malignancy (HM).
Methods
Adults in Montefiore Medical Center with a HBsAg test between Jan 1st 2001 and Dec 31st 2011 were identified. Those with a positive serum protein electrophoresis (SPEP) test were included. SPEP results were classified into faint (F-SPEP) and discrete (D-SPEP). Demographics, results of Hepatitis C and HIV serology were obtained. Cancer registry data were reviewed for a diagnosis of biopsy confirmed HM.
Results
216,522 patients were tested for HBsAg. 3,177 were positive. 346 of 3,177 HBsAg+ (10.9%) had an SPEP test. 66 of 346 (19%) had a +SPEP. 15 (4.5%) had a D-SPEP and 51 (14.5%) had a F-SPEP. Of the 213,345 HBsAg-, 21,291 (9.9%) had a SPEP. 2,226 of 21,291 (10.5%) were SPEP+. 739 (3.3%) had a D-SPEP and 1487 (7.2%) had a F-SPEP. HBsAg+ patients were more likely to be SPEP+ than HBsAg-. (19% vs 10.5%, p<0.0001)Patients with +SPEP among HBsAg+ and HBsAg- were compared. (Table 1) HBsAg+ SPEP+ patients were more likely to be male (69.7% vs 47.9%, p<0.001), more likely tested for HIV (OR:3.7, 95% CI: 2.1-6.4) and to be HIV positive (OR:2.3, 95% CI: 1.3-4.1) . HBsAg+ SPEP+ patients were 6.7 times more likely to have a HM compared to HBsAg- SPEP+ patients. (OR: 6.7, 95% CI 3.5-12.7) The types of HM identified in the groups is described in Table 2. Table 1. HBsAg- SPEP+ versus HBsAg+ SPEP+ patients
Table 2. Malignancies in HBsAg+ and HBsAg- patients with +SPEP
Conclusion
Our study shows that paraproteinemia is more prevalent in HBsAg+ patients, and HBsAg+SPEP+ patients are at a greater risk of developing HM compared to HBsAg- SPEP- Virus dependent B cell proliferation may be involved in Hepatitis B lymphomagenesis and paraproteins may be a marker. Modest frequency of HIV testing in our retrospective cohort is a significant limitation.
Session topic: E-poster
Keyword(s): Hematological malignancy, Hepatitis B virus, Monoclonal gammopathy
Type: Eposter Presentation
Background
Hepatitis B virus is lymphotropic and persists in peripheral blood mononuclear cells for years after active infection. In chronic infection, persistent antigenic stimulation of lymphocytes occurs. Whether these effects of the virus on B cells increase the risk of paraproteinemia and its progression is unknown.
Aims
We proposed to compare HBsAg+ versus HBsAg negative patients identified in the same time frame for prevalence of paraproteins and risk of development of hematological malignancy (HM).
Methods
Adults in Montefiore Medical Center with a HBsAg test between Jan 1st 2001 and Dec 31st 2011 were identified. Those with a positive serum protein electrophoresis (SPEP) test were included. SPEP results were classified into faint (F-SPEP) and discrete (D-SPEP). Demographics, results of Hepatitis C and HIV serology were obtained. Cancer registry data were reviewed for a diagnosis of biopsy confirmed HM.
Results
216,522 patients were tested for HBsAg. 3,177 were positive. 346 of 3,177 HBsAg+ (10.9%) had an SPEP test. 66 of 346 (19%) had a +SPEP. 15 (4.5%) had a D-SPEP and 51 (14.5%) had a F-SPEP. Of the 213,345 HBsAg-, 21,291 (9.9%) had a SPEP. 2,226 of 21,291 (10.5%) were SPEP+. 739 (3.3%) had a D-SPEP and 1487 (7.2%) had a F-SPEP. HBsAg+ patients were more likely to be SPEP+ than HBsAg-. (19% vs 10.5%, p<0.0001)Patients with +SPEP among HBsAg+ and HBsAg- were compared. (Table 1) HBsAg+ SPEP+ patients were more likely to be male (69.7% vs 47.9%, p<0.001), more likely tested for HIV (OR:3.7, 95% CI: 2.1-6.4) and to be HIV positive (OR:2.3, 95% CI: 1.3-4.1) . HBsAg+ SPEP+ patients were 6.7 times more likely to have a HM compared to HBsAg- SPEP+ patients. (OR: 6.7, 95% CI 3.5-12.7) The types of HM identified in the groups is described in Table 2. Table 1. HBsAg- SPEP+ versus HBsAg+ SPEP+ patients
| Characteristic | HBsAg- SPEP+ (n=2226) | HBsAg+ SPEP+ (n=66) | p value |
| Male (n, %) | 1067 (47.9%) | 46 (69.7%) | <0.0001 |
| HCV serology tested | 2047 (92%) | 65 (98.5%) | 0.052 |
| HCV positive/ tested for HCV | 370 /2047 (18.1%) | 12/65 (18.5%) | 0.937 |
| HIV serology tested | 974 (43.8%) | 49 (74.2%) | <0.0001 |
| HIV positive / tested for HIV | 319/974 (32.8%) | 26/49 (53.1%) | 0.003 |
| D-SPEP positive | 739 (33.2%) | 15 (22.7%) | 0.074 |
| F-SPEP positive | 1487 (66.8%) | 51 (77.3%) | 0.074 |
| HM positive | 79 (3.5%) | 13 (19.7%) | <0.001 |
| Type of HM | HBsAg- SPEP+ HM+ (n=79) | HBsAg+ SPEP+ HM+ (n=13) |
| Plasma cell neoplasm | 18 (21.4%) | 8 (44.4%) |
| High grade B cell lymphoma/ Acute lymphoblastic leukemia | 14 (16.7%) | 1 (5.6%) |
| Low grade B cell lymphoma | 26 (31%) | 2 (11.1%) |
| T cell or NK cell lymphoma | 8 (9.5%) | 0 |
| Acute myeloid leukemia or myelodysplasia | 9 (10.7%) | 1 (5.6%) |
| Myeloproliferative syndromes | 4 (4.8%) | 1 (5.6%) |
Conclusion
Our study shows that paraproteinemia is more prevalent in HBsAg+ patients, and HBsAg+SPEP+ patients are at a greater risk of developing HM compared to HBsAg- SPEP- Virus dependent B cell proliferation may be involved in Hepatitis B lymphomagenesis and paraproteins may be a marker. Modest frequency of HIV testing in our retrospective cohort is a significant limitation.
Session topic: E-poster
Keyword(s): Hematological malignancy, Hepatitis B virus, Monoclonal gammopathy
Abstract: E1251
Type: Eposter Presentation
Background
Hepatitis B virus is lymphotropic and persists in peripheral blood mononuclear cells for years after active infection. In chronic infection, persistent antigenic stimulation of lymphocytes occurs. Whether these effects of the virus on B cells increase the risk of paraproteinemia and its progression is unknown.
Aims
We proposed to compare HBsAg+ versus HBsAg negative patients identified in the same time frame for prevalence of paraproteins and risk of development of hematological malignancy (HM).
Methods
Adults in Montefiore Medical Center with a HBsAg test between Jan 1st 2001 and Dec 31st 2011 were identified. Those with a positive serum protein electrophoresis (SPEP) test were included. SPEP results were classified into faint (F-SPEP) and discrete (D-SPEP). Demographics, results of Hepatitis C and HIV serology were obtained. Cancer registry data were reviewed for a diagnosis of biopsy confirmed HM.
Results
216,522 patients were tested for HBsAg. 3,177 were positive. 346 of 3,177 HBsAg+ (10.9%) had an SPEP test. 66 of 346 (19%) had a +SPEP. 15 (4.5%) had a D-SPEP and 51 (14.5%) had a F-SPEP. Of the 213,345 HBsAg-, 21,291 (9.9%) had a SPEP. 2,226 of 21,291 (10.5%) were SPEP+. 739 (3.3%) had a D-SPEP and 1487 (7.2%) had a F-SPEP. HBsAg+ patients were more likely to be SPEP+ than HBsAg-. (19% vs 10.5%, p<0.0001)Patients with +SPEP among HBsAg+ and HBsAg- were compared. (Table 1) HBsAg+ SPEP+ patients were more likely to be male (69.7% vs 47.9%, p<0.001), more likely tested for HIV (OR:3.7, 95% CI: 2.1-6.4) and to be HIV positive (OR:2.3, 95% CI: 1.3-4.1) . HBsAg+ SPEP+ patients were 6.7 times more likely to have a HM compared to HBsAg- SPEP+ patients. (OR: 6.7, 95% CI 3.5-12.7) The types of HM identified in the groups is described in Table 2. Table 1. HBsAg- SPEP+ versus HBsAg+ SPEP+ patients
Table 2. Malignancies in HBsAg+ and HBsAg- patients with +SPEP
Conclusion
Our study shows that paraproteinemia is more prevalent in HBsAg+ patients, and HBsAg+SPEP+ patients are at a greater risk of developing HM compared to HBsAg- SPEP- Virus dependent B cell proliferation may be involved in Hepatitis B lymphomagenesis and paraproteins may be a marker. Modest frequency of HIV testing in our retrospective cohort is a significant limitation.
Session topic: E-poster
Keyword(s): Hematological malignancy, Hepatitis B virus, Monoclonal gammopathy
Type: Eposter Presentation
Background
Hepatitis B virus is lymphotropic and persists in peripheral blood mononuclear cells for years after active infection. In chronic infection, persistent antigenic stimulation of lymphocytes occurs. Whether these effects of the virus on B cells increase the risk of paraproteinemia and its progression is unknown.
Aims
We proposed to compare HBsAg+ versus HBsAg negative patients identified in the same time frame for prevalence of paraproteins and risk of development of hematological malignancy (HM).
Methods
Adults in Montefiore Medical Center with a HBsAg test between Jan 1st 2001 and Dec 31st 2011 were identified. Those with a positive serum protein electrophoresis (SPEP) test were included. SPEP results were classified into faint (F-SPEP) and discrete (D-SPEP). Demographics, results of Hepatitis C and HIV serology were obtained. Cancer registry data were reviewed for a diagnosis of biopsy confirmed HM.
Results
216,522 patients were tested for HBsAg. 3,177 were positive. 346 of 3,177 HBsAg+ (10.9%) had an SPEP test. 66 of 346 (19%) had a +SPEP. 15 (4.5%) had a D-SPEP and 51 (14.5%) had a F-SPEP. Of the 213,345 HBsAg-, 21,291 (9.9%) had a SPEP. 2,226 of 21,291 (10.5%) were SPEP+. 739 (3.3%) had a D-SPEP and 1487 (7.2%) had a F-SPEP. HBsAg+ patients were more likely to be SPEP+ than HBsAg-. (19% vs 10.5%, p<0.0001)Patients with +SPEP among HBsAg+ and HBsAg- were compared. (Table 1) HBsAg+ SPEP+ patients were more likely to be male (69.7% vs 47.9%, p<0.001), more likely tested for HIV (OR:3.7, 95% CI: 2.1-6.4) and to be HIV positive (OR:2.3, 95% CI: 1.3-4.1) . HBsAg+ SPEP+ patients were 6.7 times more likely to have a HM compared to HBsAg- SPEP+ patients. (OR: 6.7, 95% CI 3.5-12.7) The types of HM identified in the groups is described in Table 2. Table 1. HBsAg- SPEP+ versus HBsAg+ SPEP+ patients
| Characteristic | HBsAg- SPEP+ (n=2226) | HBsAg+ SPEP+ (n=66) | p value |
| Male (n, %) | 1067 (47.9%) | 46 (69.7%) | <0.0001 |
| HCV serology tested | 2047 (92%) | 65 (98.5%) | 0.052 |
| HCV positive/ tested for HCV | 370 /2047 (18.1%) | 12/65 (18.5%) | 0.937 |
| HIV serology tested | 974 (43.8%) | 49 (74.2%) | <0.0001 |
| HIV positive / tested for HIV | 319/974 (32.8%) | 26/49 (53.1%) | 0.003 |
| D-SPEP positive | 739 (33.2%) | 15 (22.7%) | 0.074 |
| F-SPEP positive | 1487 (66.8%) | 51 (77.3%) | 0.074 |
| HM positive | 79 (3.5%) | 13 (19.7%) | <0.001 |
| Type of HM | HBsAg- SPEP+ HM+ (n=79) | HBsAg+ SPEP+ HM+ (n=13) |
| Plasma cell neoplasm | 18 (21.4%) | 8 (44.4%) |
| High grade B cell lymphoma/ Acute lymphoblastic leukemia | 14 (16.7%) | 1 (5.6%) |
| Low grade B cell lymphoma | 26 (31%) | 2 (11.1%) |
| T cell or NK cell lymphoma | 8 (9.5%) | 0 |
| Acute myeloid leukemia or myelodysplasia | 9 (10.7%) | 1 (5.6%) |
| Myeloproliferative syndromes | 4 (4.8%) | 1 (5.6%) |
Conclusion
Our study shows that paraproteinemia is more prevalent in HBsAg+ patients, and HBsAg+SPEP+ patients are at a greater risk of developing HM compared to HBsAg- SPEP- Virus dependent B cell proliferation may be involved in Hepatitis B lymphomagenesis and paraproteins may be a marker. Modest frequency of HIV testing in our retrospective cohort is a significant limitation.
Session topic: E-poster
Keyword(s): Hematological malignancy, Hepatitis B virus, Monoclonal gammopathy
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