Does EBV, Immunosuppression Affect Outcomes in B-Cell Lymphomas?
A recent study examined whether a history of Epstein-Barr virus (EBV) positivity or immunosuppression affects outcomes in patients with a type of B-cell lymphoma, published in Haematologica (November 2017;102).
EBV-positive diffuse large B-cell lymphoma (DLBCL) represents between 2% and 16% of all documented DLBCL cases in Asia or Latin countries. Positive status has been associated with advanced stage, extranodal disease, constitutional symptoms, and low rates of response to chemotherapy. Prior studies in Western patients have shown a lower incidence of EBV and a poor correlation with aggressive clinical features.
Sean I Tracy, MD, PhD, Mayo Clinic (Rochester, MN), and colleagues conducted a study to determine the prevalence, clinical correlations, and prognosis of EBV-positive DLBCL among patients residing in the upper Midwestern United States. Researchers sampled 362 patients with newly diagnosed disease who had available tissue arrays. All tissue samples were tested for EBV, and a history of significant congenital or iatrogenic immunosuppression was evaluated for all patients.
Researchers acknowledged that at baseline, 4.4% of samples tested positive for EBV and 10.8% of patients had a significant history of immunosuppression.
Those who tested positive for EBV demonstrated no unique clinical characteristics. However, researchers observed a higher frequency of CD30 positivity (25% vs 8.1%, respectively; P < .01) and non-germinal-center subtype (62.5% VS 34.1%, respectively; P < .01) in EBV-positive patients compared with EBV-negative patients. Furthermore, bone marrow involvement with large-cell lymphoma was more frequent in patients with EBV-positive disease (43.8% vs 18.5%, respectively; P = .03).
Additionally, researchers reported that a median follow-up of 59 months yielded no association between EBV positivity or immunosuppression and event-free survival at 2 years or overall survival.
“We conclude that among white North American patients, a history of immunosuppression is unlikely to confer an adverse prognosis,” Dr Tracy and colleagues wrote. Further research involving subsequent cohorts and standardized definitions of immunosuppression are needed to verify these results, they added.—Zachary Bessette