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Thank you for addressing the reviewer's comments.
[# PeerJ Staff Note - this decision was reviewed and approved by Valeria Souza, a PeerJ Section Editor covering this Section #]
I have no other comments
I have no other comments
i have no further comments
I have no further comments
Please address the reviewer's final minor comments and resubmit the revised manuscript.
Overall, the authors have presented a well-written study.
However, the article should be carefully reviewed for typos.
Some examples:
Line 57: “HBV infectionn”
Line 151: “and and the most appropriate”
Line 76: I believe I understand the authors intent regarding HBV reactivation. However, the current statement is still very problematic. I suggest deleting: “…and the use of new therapeutics for MM.”. I believe this will solve the problematic statement suggesting use of new therapeutics causes HBV infection.
No further comments
this section has been improved
this section has been improved
the authors have made findings validity
no additional comments now
Please address the reviewer's comments and submit the revised manuscript.
The introduction is well written and packed with references.
However in Line 71: The authors state: “The increased predisposition to HBV infection in patients with MM is complex and related to multiple factors…and the use of new therapeutics for MM”- Do the authors mean new therapeutics for MM cause HBV infection? Please explain or rephrase.
Line 113: “Once HBV reactivation was detected, antiviral therapy would start immediately.”- Since this is a retrospective study, the purpose of this statement is not clear. Was this the common practice at the medical center? In the results section the authors claim prophylactic therapy was given to 152 patients. This contradicts the previous statement. The authors need to clarify this section.
According to Supplemental table 2 there were 3 patients with reactivation of HBV who were HBcAb negative and HBsAg negative. Were they also given anti-viral treatment as prophylactic therapy, or did they initiate treatment only after reactivation was identified?
Supplemental table 2 is also missing HBV DNA at diagnosis of MM. This is extremely important for the detection of HBV reactivation in HBsAg positive patients. For example, patient 14, is an HBsAg positive patient who during “reactivation” had a viral load of 1.01E+03 IU/ml. This very low viral load seems to be quite low for a reactivation. Proper identification of reactivation cases based on the criteria defined in the methods section is paramount for any conclusions drawn from this study. Please add this important column to the table.
This is a very interesting study with important results.
However, data regarding reactivation and timing of anti-viral treatment needs more clarifications.
The study opens up possibilities for further research into optimal treatment strategies to prevent HBV reactivation in NDMM patients, including the use of antiviral prophylaxis. However the following items should be focused.
1\ the Englished should be improved
2\ The lines in the figures are too light
- The retrospective design of the study is appropriate to assess the frequency and prognosis of HBV reactivation in NDMM patients, but prospective studies may be needed to confirm these results and investigate causality.
- The sample size (355 patients, 33 of whom experienced HBV reactivation) appears sufficient for an initial analysis, but may be limiting when considering subgroups or performing more detailed multivariate analyzes. A larger cohort could corroborate the results.
- The authors do not mention the geographical or ethnic composition of the cohort.
- There is no mention of how HBV reactivation was dealt with once it was detected, which could also affect survival prospects.
- Have the patients received prophylaxis against HBV reactivation?
The conclusion that HBV reactivation is a significant complication with unfavorable prognostic implications. However, the manuscript should ideally discuss how these results can be reconciled with current clinical practice and what changes could be recommended.
This study has the potential to significantly impact clinical practice by raising awareness of HBV reactivation as a possible complication in NDMM patients. The identification of risk factors could help in the development of prevention and early detection strategies, which would ultimately lead to better outcomes for these patients.
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