Elevated Incidence of Viral Hepatitis in Splenic Marginal Zone Lymphoma Patients in Romania
Overview
A retrospective study of 34 splenic marginal zone lymphoma (SMZL) cases in Romania revealed a higher than expected incidence of SMZL among lymphomas and a notable association with hepatitis B and C infections. Among 17 cases tested for viral status, 29.4% were positive for HBV or HCV, suggesting a potential link between chronic viral hepatitis and SMZL.
Background
Splenic marginal zone lymphoma (SMZL) is an indolent subtype of non-Hodgkin lymphoma representing approximately 2% of lymphoid neoplasms. Epidemiological data have linked SMZL to chronic infections, particularly hepatitis C virus (HCV). This study analyzed lymphoma cases diagnosed over a decade at a Romanian oncology institute to assess the incidence of SMZL and its association with viral hepatitis and HIV infections.
Data Highlights
Parameter
Value
Total lymphoma cases
731
Hodgkin lymphoma cases
160 (21.9%)
Non-Hodgkin lymphoma cases
571 (78.1%)
SMZL cases
34 (4.7% of all lymphomas; 6.0% of NHLs)
Male-to-female ratio in SMZL
1.8 (22 males, 12 females)
Median age (SMZL patients)
63 years (range 39–77)
Cases with viral status available
17
HBV or HCV positive cases
5 (29.4%)
HCV positive
2 (11.7%)
HBV positive
3 (17.7%)
HIV and HDV negative cases
All tested
Median follow-up
51 months
Survival at analysis (viral status known)
12/17 (70.6%) alive
Key Findings
SMZL represented 4.7% of all lymphoma cases and 6.0% of NHLs, approximately double the expected incidence.
Among 17 SMZL patients tested, 29.4% were positive for hepatitis B or C, with no cases positive for HIV or hepatitis D.
Bone marrow biopsy showed lymphoma involvement in all tested cases, predominantly with interstitial and intrasinusoidal infiltration patterns.
Two cases showed transformation to diffuse large B-cell lymphoma, each associated with either HCV or HBV infection.
Immunophenotyping confirmed typical SMZL markers: positive for CD20 and CD79a, negative for CD5, CD23, and cyclin D1.
Survival analysis indicated a borderline difference in overall survival between viral hepatitis positive and negative groups (P=0.055).
Clinical Implications
Clinicians should be aware of the elevated incidence of SMZL in regions with high HBV and HCV prevalence, as chronic viral hepatitis may contribute to lymphomagenesis. Screening for viral hepatitis in SMZL patients is advisable to guide management and monitor for potential lymphoma transformation. Awareness of viral status may also inform prognosis and therapeutic decisions.
Conclusion
This study highlights a higher than expected incidence of SMZL in Romania and a significant association with hepatitis B and C infections, underscoring the importance of viral screening in SMZL patients. Further research is warranted to elucidate the pathogenetic role of chronic viral hepatitis in SMZL development and progression.
References
Study Authors/Institute/2016 -- Elevated Incidence of Viral Hepatitis in Patients with Splenic Marginal Zone Lymphoma in Romania
