Clinical outcome of Epstein–Barr virus‐positive diffuse large B‐cell lymphoma of the elderly in the rituximab era

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of malignant lymphoma. The incidence of Epstein–Barr virus (EBV)-positive DLBCL in Asian and Latin American countries ranges from 8 to 10%. The prognosis of patients with EBV-positive DLBCL is controversial. To compare the clinical outcome of EBV-positive and EBV-negative patients with DLBCL in the rituximab era, we analyzed 239 patients with de novo DLBCL diagnosed between January 2007 and December 2011. The presence of EBV in lymphoma cells was detected using EBV-encoded RNA in situ hybridization, and it was found that 18 (6.9%) of 260 patients with diagnosed DLBCL tested positive. Among the 260 cases, 216 cases were treated with rituximab plus chemotherapy, as were 8 EBV-positive DLBCL patients. The median overall survival and progression-free survival times in patients with EBV-positive DLBCL were 8.7 months and 6.8 months, respectively. The median overall survival and progression-free survival could not be determined in EBV-negative DLBCL patients (P = 0.0002, P < 0.0001, respectively). The outcome of patients with EBV-positive DLBCL remains poor, even in the rituximab era.

Reappraisal of Epstein–Barr virus (EBV) in diffuse large B‐cell lymphoma (DLBCL): comparative analysis between EBV‐positive and EBV‐negative DLBCL with EBV‐positive bystander cells

“…In addition, EBV− DLBCL patients with EBV+ bystander cells had a poor prognosis, with 33% (7/21) of patients having a lethal clinical course within 2 years after diagnosis, even with multiagent chemotherapy. Rituximab has been reported to improve the outcome of DLBCL patients, but has not demonstrated sufficient efficacy in EBV+ DLBCL . In our study, immunochemotherapy appeared to improve the prognosis of EBV− DLBCL patients with EBV+ bystander cells more than that of EBV+ DLBCL patients, but the difference was not significant.…”

EBV‐positive diffuse large B‐cell lymphoma of the elderly: 2016 update on diagnosis, risk‐stratification, and management

“…Similar results were found in a Korean study that evaluated 18 patients with EBV-positive DLBCL, who had similar OS rates to 204 EBV-negative patients with 3-year OS rates of 57% and 60%, respectively [32]. Conversely, a recent Japanese study showed a median OS of 9 months in 8 patients with EBV-positive DLBCL treated with R-CHOP while the median OS for EBV-negative patients was not reached [33]. An Spanish study on 47 patients with EBVpositive DLBCL of the elderly mostly treated with R-CHOP-like regimens showed 2-year OS rate of 40%, which appeared lower than patients with EBV-negative DLBCL [14].…”

EBV-positive large B-cell lymphomas in young patients: a nodal lymphoma with evidence for a tolerogenic immune environment

“…2,[4][5][6][7][8][9][10] It is defined as an aggressive EBV 1 monoclonal B-cell proliferation arising in patients .50 years of age in the absence of recognized immunodeficiency or iatrogenic immunosuppression. 3 Most cases have an activated/nongerminal center B-cell immunophenotype (ABC/non-GCB).…”

“…3 Most cases have an activated/nongerminal center B-cell immunophenotype (ABC/non-GCB). 4,6,7,[9][10][11] Senescence of the immune system inherent to the aging process leading to defective surveillance of EBV is thought to play a major role in pathogenesis.…”