Peripheral T-cell lymphomas (PTCLs) are rare and have a dismal prognosis. The most frequent subtype is PTCL, unspecified. Epstein-Barr virus (EBV) has been detected in around 40% of cases, but its prognostic significance is not fully established. Lymph node samples from 110 patients with PTCL, unspecified included in LNH87 and LNH93 trials were available. EBV status was studied by EBV-encoded small RNA in situ hybridization (EBER-ISH). EBER-ISH showed positive cells in 45 (41%) of 110 patients. Pretreatment characteristics were comparable between positive and negative cases, except for male sex (80% versus 60%, respectively, P ؍ .02). Only 50% of patients achieved complete remission with a 5-year eventfree survival (EFS) and overall survival (OS) of 21% and 30%, respectively. EBER-ISH positivity was the sole factor linked with worse EFS, with a 5-year probability of 11% for positive patients. In univariate analysis, factors affecting OS were EBER-ISH positivity, high LDH level, and age older than 60 years. In multivariate analysis, EBER-ISH was associated with a worse OS in the elderly population. Timedependent analysis showed that the negative impact of EBV was essentially seen in the first 2 years following diagnosis. These results warrant further studies regarding pathogenesis and specific treatment approaches for EBV-associated PTCL patients.
IntroductionT-cell lymphomas are rare in Europe and the United States, where they represent around 15% of non-Hodgkin lymphomas. 1,2 As we and others have shown, a T-cell immunophenotype (except for anaplastic large cell lymphoma) is an independent predictor of poor prognosis in aggressive lymphomas. 1,3,4 The WHO classification of lymphoid tumors recognizes 16 different entities among peripheral (mature) T-and natural killer (NK)-cell neoplasms. 5 Among these, the entity peripheral T-cell lymphoma, unspecified (PTCL-U) accounts for about half the cases of PTCL seen in Western countries. 3,6-8 PTCL-U forms a heterogeneous group of predominantly nodal (and occasionally extranodal) diseases that do not fit into the definition of any other recognizable subtype of PTCL. Although their histopathological aspect is highly variable, usual morphologic characteristics include pleomorphic cellular composition, and frequently a polymorphous inflammatory background. 5 Most cases display a CD4 ϩ /CD8 Ϫ helper T-cell phenotype, less frequent cases showing a cytotoxic CD4 Ϫ /CD8 ϩ /TIA1 ϩ /granzyme B ϩ phenotype, which has been linked by certain authors to a worse outcome. 9 Efforts to identify different entities with pathophysiologic and prognostic significance among PTCL-U are ongoing. 10,11 Epstein-Barr virus (EBV), the etiologic agent of infectious mononucleosis, has been linked to a wide range of tumors, mainly of B-cell origin. 12 Association of PTCLs with EBV has been first described in the late 1980s, 13 and has since been found to be present in an important fraction of cases in series from Asia [14][15][16][17][18][19] and from Western countries. [20][21][22][23] While some...