The impact of HBV vaccination on B-cell non-Hodgkin lymphoma

Jerry POLESEL, CRO Aviano National Cancer Institute, Italy
DAL MASO L. 1 , LIBRA M. 4 , TEDESCHI R. 3 , MONTELLA M. 2 , ZUCCHETTO A. 1 , TABORELLI M. 1 , SERRAINO D. 1

1 Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
2 Unit of Epidemiology, National Cancer Institute "G. Pascale Foundation", Naples, Italy
3 Unit of Microbiology, Immunology and Virology, CRO Aviano National Cancer Institute, Aviano, Italy
4 Department of Biomedical Sciences, University of Catania, Catania, Italy

Purpose: To evaluate the risk of B-cell non-Hodgkin lymphoma (NHL) associated to HBV infection and the fraction of cancer preventable through vaccination.
 
Methods: We conducted a case-control study in Italy in 1999-2014, enrolling 513 incident, histologically confirmed B-cell NHLs. Controls were 997 cancer-free patients hospitalized for diseases unrelated to infectious and auto-immune diseases. Controls were matched to cases according to study centre, period, sex and age group. Study subjects provided serum for HBV and HCV screening (HCV and HBV serology, HCV viral load). Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated by logistic regression, adjusting for potential confounders.
 
Results: Chronic HBV infection (HBsAg+) was reported in 20 NHL cases (3.9%) and 17 control (1.7%). No patients were coinfected with HCV. Compared to people susceptible to HBV infection (HBsAg–, antiHBc–, antiHBs–), those with chronic HBV infection had a two-fold higher risk of B-cell NHL (95% CI: 1.07-4.15). Accordingly, 2.9% (95% CI: 1.5-4.2%) of B-cell NHL cases were attributable to chronic HBV infection. No excess of B-cell NHL risk emerged in people with serological evidence of past/immune HBV infection (HBsAg–, antiHBc+, antiHBs+; OR=0.79; 95% CI: 0.58-1.10) or vaccination (HBsAg–, antiHBc–, antiHBs+; OR=0.87; 95% CI: 0.58-1.31). The effect of vaccination was consistent across sex (OR=0.91 among men and 0.86 among women) and age groups (OR=0.78 and 1.04 among people aged <50 or ≥50 years).
 
Conclusions: Our results lend additional support to the role of chronic HBV infection in the development of B-cell NHL. The primary prevention of HBV infection through vaccination and the promotion of safe behaviors may reduce the incidence of B-cell NHL of approximately 3%. HBV vaccination could have greater impact on the reduction of B-cell NHL cases in endemic areas where prevalence of HBV is much higher.
 
Funding source: Italian Association for the Research on Cancer