Concurrent antiviral–immunochemotherapy strategy safely overcomes high hepatitis B viral load barrier in diffuse large B‐cell lymphoma: A multicentre cohort study

Summary 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: <10 4 IU/mL, n = 82; high: ≥10 4 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 × 10 6 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.