Concurrent antiviral-immunochemotherapy strategy safely overcomes high hepatitis B viral load barrier in diffuse...

Although antiviral prophylaxis is standard for lymphoma patients with chronic hepatitis B virus (HBV) infection to prevent HBV reactivation (HBVr), the optimal timing for high-risk patients (baseline HBV deoxyribonucleic acid (DNA) ≥4 log10 IU/mL) during immunochemotherapy remains unclear. A multicentre retrospective study analysed 112 chronic HBV patients among 1120 newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients, stratified by baseline viral load (low: <10⁴ IU/mL, n = 82; high: ≥10⁴ IU/mL, n = 30). We assessed antiviral timing, virological dynamics and clinical outcomes. Antivirals (mainly entecavir) suppressed HBV DNA to undetectable levels in high-load patients (median start 1.65 × 10⁶ IU/mL; p = 0.001). The 3-year cumulative HBVr rates were low (4.2% overall; 4.5% high vs. 4.1% low load, p = 0.955), with one fatal HBVr after discontinuation. Liver toxicity was mild (grade 1-2 transaminase elevations: 33.3%-36.7%). High and low viral load groups achieved comparable 3-year progression-free survival (80.9% vs. 70.6%, p = 0.137), overall response rates (86.7% vs. 82.9%) and complete remission rates (70.0% vs. 64.6%). Propensity score-matched analysis confirmed no significant differences in progression-free survival or HBVr. Concurrent initiation of antiviral prophylaxis with immunochemotherapy is safe and effective, preventing HBVr and enabling timely immunochemotherapy in DLBCL patients with high HBV DNA levels.