Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy

169

120

Section: Discussionmentioning

confidence: 59%

The clinical significance of EBV DNA in the plasma and peripheral blood mononuclear cells of patients with or without EBV diseases

Kanakry¹,

Hegde²,

Durand

et al. 2016

169

120

“…19 In EBV(1) extranodal natural killer/T-cell lymphoma, the use of pretreatment plasma EBV-DNA measurements to assign patients to more intensive vs less intensive therapy is currently being prospectively investigated by other researchers, based on findings that high-plasma EBV-DNA at presentation is an independent predictor of inferior FFS for these lymphomas. 20,21 If our findings in HL are confirmed in a validation sample, assessment of pretreatment plasma EBV-DNA may aid in risk-stratification.…”

Section: Discussionmentioning

confidence: 76%

Plasma Epstein-Barr virus DNA predicts outcome in advanced Hodgkin lymphoma: correlative analysis from a large North American cooperative group trial

Kanakry

Gellert

et al. 2013

117

• Plasma EBV-DNA is highly concordant with EBV tumor status in Hodgkin lymphoma.• Plasma EBV-DNA has prognostic significance in Hodgkin lymphoma, both before therapy and at month 6 of follow-up.Epstein-Barr virus (EBV) is associated with Hodgkin lymphoma (HL) and can be detected by in situ hybridization (ISH) of viral nucleic acid (EBER) in tumor cells. We sought to determine whether plasma EBV-DNA could serve as a surrogate for EBER-ISH and to explore its prognostic utility in HL. Specimens from the Cancer Cooperative Intergroup Trial E2496 were used to compare pretreatment plasma EBV-DNA quantification with EBV tumor status by EBER-ISH. A cutoff of >60 viral copies/100 mL plasma yielded 96% concordance with EBER-ISH. Pretreatment and month 6 plasma specimens were designated EBV(-) or EBV(1) by this cutoff. Patients with pretreatment EBV(1) plasma (n 5 54) had inferior failure-free survival (FFS) compared with those with pretreatment EBV(-) plasma (n 5 274), log-rank P 5 .009. By contrast, no difference in FFS was observed when patients were stratified by EBER-ISH. Pretreatment plasma EBV positivity was an independent predictor of treatment failure on multivariate analyses. At month 6, plasma EBV(1) patients (n 5 7) had inferior FFS compared with plasma EBV(-) patients (n 5 125), log-rank P 5 .007. These results confirm that plasma EBV-DNA is highly concordant with EBER-ISH in HL and suggest that it may have prognostic utility both at baseline and after therapy. This trial was registered at www.clinicaltrials.gov as #NCT00003389. (Blood. 2013;121(18):3547-3553)

“…In a recent study of 87 patients treated with SMILE, only IPI but not the Korean prognostic score was significant, suggesting that when new regimens are used, prognostic scores must be reappraised. 24 Furthermore, biological parameters such as circulating EBV DNA 47,48,73 and interim PET/CT findings should also be considered in the construction of future prognostic models.…”

Section: Prognostic Indicatorsmentioning

confidence: 99%

How I treat NK/T-cell lymphomas

Tse

Kwong

2013

269

281

Natural killer (NK)/T-cell lymphomas and NK-cell leukemias are aggressive malignancies. Occurring worldwide, they show a predilection for Asian and South American populations. Neoplastic cells are surface CD3−, cytoplasmic CD3ε+, CD56+, cytotoxic-molecule positive, Epstein-Barr virus (EBV) positive, with germline T-cell receptor gene. Lymphomas occur commonly in the nasal and upper aerodigestive region. Occasional cases present in the skin, salivary gland, testis, and gastrointestinal tract. Rare cases are disseminated with lymphadenopathy, hepatosplenomegaly, and a leukemic phase. Positron emission tomography computed tomography is useful in staging, as lymphomas are 18-fluorodeoxyglucose avid. Quantification of circulating EBV DNA is an accurate biomarker of tumor load. Nasal NK/T-cell lymphomas present mostly with stage I/II disease. Concomitant/sequential chemotherapy and radiotherapy is standard treatment. Radiotherapy alone is inadequate because of high systemic failure rate. For stage III/IV nasal, nonnasal, and disseminated lymphomas, systemic chemotherapy is indicated. Regimens containing l-asparaginase and drugs unaffected by P-glycoprotein are most effective. Hematopoietic stem cell transplantation (HSCT) is not indicated for early-stage nasal lymphomas. HSCT for lymphomas not in remission has poor results. In advanced-stage nasal, nonnasal, disseminated, or relapsed lymphomas, HSCT may be considered when remission is achieved. Prognostic modeling and EBV DNA monitoring may be useful in risk stratification for HSCT.