Assessment of tumor Epstein-Barr Virus status and its impact on outcomes in intermediate and high-risk childhood classic Hodgkin Lymphoma treated at a tertiary cancer center in India

The prognostic value of Epstein−Barr virus infection in Hodgkin lymphoma: A systematic review and meta-analysis

“…The ending endpoint was PFS in a small number of articles ( 23 , 39 , 47 , 50 – 52 ), and we did not perform further subgroup analyses. A child-based study from India ( 48 ) showed that EBV-positive children have longer EFS than EBV-negative children, which contradicted our finding and may be explained by the high prevalence of EBV infection in Indian children and the greater chemotherapy and radiotherapy sensitivity of infected tumor cells ( 17 ).…”

“…The reported mean or median age for studies differed widely; five studies only included patients younger than 18 years old ( 16 , 30 , 33 , 41 , 48 ), and one study only included the elderly ( 20 ). Thirty studies ( 11 , 14 , 15 , 17 , 18 , 20 – 25 , 28 – 30 , 32 – 36 , 38 , 41 , 44 – 46 , 48 – 51 , 53 , 54 ) reported the median or mean follow-up time, ranging from 25 to 130 months. In terms of methodological quality, all included studies scored more than six stars on the NOS.…”

“…In the subgroup analysis by disease distribution on six continents, the African subgroup showed that EBV-positive patients had a borderline better OS (HR=0.408, 95% CI: 0.147-1.129; P =0.084). For age distribution, some articles ( 16 , 18 , 25 , 28 , 41 , 48 , 50 , 52 ) had sufficient age-stratified survival data, so we combined their HR by a random effects model (I 2 = 62.9%, P=0.003), which was 1.080 (95% CI: 0.657-1.776; P=0.762). In the subgroup of children and adolescents, the pooled HR showed that EBV positivity in HL was correlated with a favorable outcome for OS (HR=0.296, 95% CI: 0.085-1.034, P=0.056), while a significantly poorer OS was associated with EBV positivity in studies covering older adults (HR=1.905, 95% CI: 1.380–2.629; P<0.001).…”

“…Ten studies ( 29 – 31 , 33 – 35 , 38 , 42 , 44 , 48 ) were included to analyze the impact of EBV infection on EFS. The pooled estimate showed that no significant association was found between EBV positivity and EFS (HR=0.962, 95% CI: 0.755-1.227, P=0.756; Figure 5 ).…”

“…For the survival endpoints of OS and DSS, our results are in line with 7 studies ( 20 , 28 , 36 , 39 , 46 , 47 , 49 ), and other reports describing clinical outcomes in relation to EBV status are conflicting. Many studies have not demonstrated that EBV status has an impact on prognosis ( 35 , 38 , 40 – 42 , 44 , 45 , 51 – 54 ), whereas some studies have shown that EBV-positive status is associated with a favorable clinical outcome ( 14 , 16 , 17 , 23 , 48 , 50 ). The discrepancies observed in these studies were generally due to the heterogeneous nature of the disease and the selection bias of study subjects, age groups, EBV detection, treatment regimens and the different outcome measures used.…”