Association between Epstein-Barr Virus and Classic Hodgkin Lymphoma in Jordan: A Comparative Study with Epstein-Barr Virus-associated Hodgkin Lymphoma in North America

Abstract

An association between Epstein-Barr virus and Hodgkin lymphoma has been shown in several parts of the world. The reported incidence of Epstein-Barr virus in Hodgkin lymphoma varies significantly from one country to another and ranges from <30% in Swedish patients to 100% in patients from Kenya. Using in situ hybridization for detection of Epstein-Barr virus-encoded RNA and immunohistochemistry for detection of Epstein-Barr virus latent membrane protein, we analyzed 28 cases of Hodgkin lymphoma from Jordan and 30 cases from the United States. Eight of 28 Jordanian cases and 9 of 30 North American cases were Epstein-Barr virus positive. Our studies show that the incidence of Epstein-Barr virus among Jordanian patients with Hodgkin lymphoma is similar to the rate in patients from the United States. This rate appears to be low to intermediate compared with rates in other parts of the world.

Racial/ethnic variation in EBV‐positive classical Hodgkin lymphoma in California populations

“…Prior descriptions of racial/ethnic variation in EBV-associated HL have come from international comparisons17, 19, 35–47 that generally were not based in common protocols for data collection, pathologic review, or EBV assays, and did not involve case series that were population-based17, 35–39, 41, 43, 44, 46. In a large combined international data set, we previously found the prevalence of EBV in HL tumors to be higher in non-white populations and those from economically less-developed countries, but the racial/ethnic variation in these cases was limited, and socioeconomic measures were indirect17.…”

“…Together, our findings imply an interplay of environmental and genetic factors for the etiology of EBV-positive HL that is intricate but ultimately consistent with the hypothesis that this form of HL may reflect an aberrant immune response to EBV infection 13,14 secondary to depressed immune function. 12 Prior descriptions of racial/ethnic variation in EBV-associated HL have come from international comparisons 17,19,[35][36][37][38][39][40][41][42][43][44][45][46][47] that generally were not based in common protocols for data collection, pathologic review, or EBV assays, and did not involve case series that were population-based. 17,[35][36][37][38][39]41,43,44,46 In a large combined international data set, we previously found the prevalence of EBV in HL tumors to be higher in non-white populations and those from economically less-developed countries, but the racial/ethnic variation in these cases was limited, and socioeconomic measures were indirect.…”

“…The latter is of interest given the association of EBV-positive HL with the highly polymorphic human leukocyte antigen (HLA) genes, 1,10,27,28,30,31 which vary by racial/ethnic group. [32][33][34] However, as racial/ethnic variation in EBV-defined HL has been noted primarily in international data, 17,19,[35][36][37][38][39][40][41][42][43][44][45][46][47] understanding its etiologic implications is difficult because of the varying sociocultural exposures inherent in these comparisons and the challenges in distinguishing them from genetic characteristics of the populations. This difficulty could be lessened by examining racial/ethnic patterns in the distributions of EBV-defined HL in a single population.…”

Epstein–Barr virus and Hodgkin’s lymphoma in Cairo, Egypt

“…-Europe [8,13,[31][32][33][34][35][36][37][38][39][40][41]; between 27% of cases in Sweden [41] and 56% of cases in Italy [13] were positive, with a higher rate in two reports: 79% in Switzerland [31] and 91% in Greece [8] -USA [12,[42][43][44]: between 25% and 65% of cases were positive -Australia [8]: a high frequency of positive cases (69%).…”

“…-Middle East (including Tunisia) [4][5][6][7][8][9][10][11][12]: between 28% of cases in a series from Jordan [12] and 70% of cases from Tunisia [4] were EBV-positive with HL; for Egypt [8], 50% were positive and 67% were of the NS type, which is similar to our findings -East Africa [13][14][15][16]: between 44% and 92% of cases were positive in Kenya -Central and South America [17][18][19][20][21][22][23]: between 31% of cases in Argentina [23] and 84% of cases in Peru [17] were positive -Asia [14,[24][25][26][27][28][29][30]: between 39% of cases in China [30] and 82% of cases in India [24] were positive, and the percentage of positive cases in most other countries was high (50% to 69%). For each country, the first column shows the number (n°) of cases studied whereas the other columns show the percentages of positive cases.…”