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Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma in the Elderly: A Matched Case-Control Analysis.

Song CG, Huang JJ, Li YJ, Xia Y, Wang Y, Bi XW, Jiang WQ, Huang HQ, Lin TY, Li ZM - PLoS ONE (2015)

Bottom Line: The median overall survival was 9 months for the EBV-positive patients.A matched-case control analysis suggested that EBV-positive patients had inferior survival outcomes compared with EBV-negative patients (3-year progression-free survival [PFS]: 25% vs. 76.7%, respectively; 3-year overall survival [OS]: 25% vs. 77.4%, respectively; P<0.001).The role of EBV in this disease and the optimal management of this subgroup warrants further investigation.

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.

ABSTRACT

Background: Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) in the elderly has rarely been reported. This study aimed to explore the clinical characteristics and prognosis of this entity.

Methods: In situ hybridization (ISH) analysis of Epstein-Barr virus (EBV) and immunohistochemistry was performed in 230 tumor specimens from consecutive de novo DLBCL patients over 50 years old. A matched-case control analysis (1:3) was utilized to compare EBV-positive and EBV-negative DLBCL in the elderly.

Results: A total of 16 patients (7.0%) were diagnosed with EBV-positive DLBCL. Of these 16 cases, the median age was 62 years, with a male to female ratio of 11:5. Elderly EBV-positive DLBCL patients had a higher incidence of non-germinal center B-cell (non-GCB) subtypes (87.5%) and high Ki67 (75%) and CD30 expression (93.8%). For EBV-positive patients undergoing initial chemotherapy, 7 of 16 (43.8%) had complete remission, 2 (12.5%) had partial remission, 2 (12.5%) had stable disease, and 5 (31.3%) had progressive disease. The median overall survival was 9 months for the EBV-positive patients. A matched-case control analysis suggested that EBV-positive patients had inferior survival outcomes compared with EBV-negative patients (3-year progression-free survival [PFS]: 25% vs. 76.7%, respectively; 3-year overall survival [OS]: 25% vs. 77.4%, respectively; P<0.001).

Conclusion: EBV-positive DLBCL of the elderly is associated with an inferior clinical course and inferior survival outcomes. The role of EBV in this disease and the optimal management of this subgroup warrants further investigation.

No MeSH data available.


Related in: MedlinePlus

Overall survival (OS) in EBV-positive (study group) and EBV-negative (control group) elderly DLBCL patients in a matched case-control analysis.
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pone.0133973.g001: Overall survival (OS) in EBV-positive (study group) and EBV-negative (control group) elderly DLBCL patients in a matched case-control analysis.

Mentions: The treatments of the 16 EBV-positive de novo DLBCL cases are summarized in Table 3. All of the patients with EBV-positive DLBCL in this series received CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) as first-line chemotherapy, and 8 patients received rituximab in addition to chemotherapy. No patient received curative radiotherapy pre- or post-chemotherapy, nor did any patient receive autologous stem cell transplantation (SCT) during the course of his or her disease. Following initial therapy, 7 of 16 (43.8%) cases achieved complete remission, 2 (12.5%) achieved partial remission, 2 (12.5%) had stable disease, and 5 (31.3%) had progressive disease. At the time of analysis, 14 patients (87.5%) had died; all of the deaths were due to lymphoma. The median OS time was 9 months. The 3-year PFS and OS rates were each 25%. Based on univariate analysis, the variables associated with a longer OS included the following: PS ≤1 (P = 0.033), extranodal involvement at <2 sites (P = 0.007), age-adjusted IPI (aaIPI) <2 (P = 0.001), IPI score <2 (P = 0.032), normal LDH (P = 0.002), and complete remission (CR) following initial therapy (P = 0.013). As shown in Table 4, the CR rate in the control group was significantly higher than in the study group (77.1% vs. 43.8%, P = 0.013). With a median follow-up of 47 months (range 1–121 months), the PFS and OS in the EBV-positive DLBCL group were significantly poorer than the EBV-negative DLBCL group, as shown in Figs 1 and 2 (3-year PFS: 25% vs. 76.7%; 3-year OS: 25% vs. 77.4%; P<0.001 for both PFS and OS).


Epstein-Barr Virus-Positive Diffuse Large B-Cell Lymphoma in the Elderly: A Matched Case-Control Analysis.

Song CG, Huang JJ, Li YJ, Xia Y, Wang Y, Bi XW, Jiang WQ, Huang HQ, Lin TY, Li ZM - PLoS ONE (2015)

Overall survival (OS) in EBV-positive (study group) and EBV-negative (control group) elderly DLBCL patients in a matched case-control analysis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4519250&req=5

pone.0133973.g001: Overall survival (OS) in EBV-positive (study group) and EBV-negative (control group) elderly DLBCL patients in a matched case-control analysis.
Mentions: The treatments of the 16 EBV-positive de novo DLBCL cases are summarized in Table 3. All of the patients with EBV-positive DLBCL in this series received CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) as first-line chemotherapy, and 8 patients received rituximab in addition to chemotherapy. No patient received curative radiotherapy pre- or post-chemotherapy, nor did any patient receive autologous stem cell transplantation (SCT) during the course of his or her disease. Following initial therapy, 7 of 16 (43.8%) cases achieved complete remission, 2 (12.5%) achieved partial remission, 2 (12.5%) had stable disease, and 5 (31.3%) had progressive disease. At the time of analysis, 14 patients (87.5%) had died; all of the deaths were due to lymphoma. The median OS time was 9 months. The 3-year PFS and OS rates were each 25%. Based on univariate analysis, the variables associated with a longer OS included the following: PS ≤1 (P = 0.033), extranodal involvement at <2 sites (P = 0.007), age-adjusted IPI (aaIPI) <2 (P = 0.001), IPI score <2 (P = 0.032), normal LDH (P = 0.002), and complete remission (CR) following initial therapy (P = 0.013). As shown in Table 4, the CR rate in the control group was significantly higher than in the study group (77.1% vs. 43.8%, P = 0.013). With a median follow-up of 47 months (range 1–121 months), the PFS and OS in the EBV-positive DLBCL group were significantly poorer than the EBV-negative DLBCL group, as shown in Figs 1 and 2 (3-year PFS: 25% vs. 76.7%; 3-year OS: 25% vs. 77.4%; P<0.001 for both PFS and OS).

Bottom Line: The median overall survival was 9 months for the EBV-positive patients.A matched-case control analysis suggested that EBV-positive patients had inferior survival outcomes compared with EBV-negative patients (3-year progression-free survival [PFS]: 25% vs. 76.7%, respectively; 3-year overall survival [OS]: 25% vs. 77.4%, respectively; P<0.001).The role of EBV in this disease and the optimal management of this subgroup warrants further investigation.

View Article: PubMed Central - PubMed

Affiliation: Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.

ABSTRACT

Background: Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) in the elderly has rarely been reported. This study aimed to explore the clinical characteristics and prognosis of this entity.

Methods: In situ hybridization (ISH) analysis of Epstein-Barr virus (EBV) and immunohistochemistry was performed in 230 tumor specimens from consecutive de novo DLBCL patients over 50 years old. A matched-case control analysis (1:3) was utilized to compare EBV-positive and EBV-negative DLBCL in the elderly.

Results: A total of 16 patients (7.0%) were diagnosed with EBV-positive DLBCL. Of these 16 cases, the median age was 62 years, with a male to female ratio of 11:5. Elderly EBV-positive DLBCL patients had a higher incidence of non-germinal center B-cell (non-GCB) subtypes (87.5%) and high Ki67 (75%) and CD30 expression (93.8%). For EBV-positive patients undergoing initial chemotherapy, 7 of 16 (43.8%) had complete remission, 2 (12.5%) had partial remission, 2 (12.5%) had stable disease, and 5 (31.3%) had progressive disease. The median overall survival was 9 months for the EBV-positive patients. A matched-case control analysis suggested that EBV-positive patients had inferior survival outcomes compared with EBV-negative patients (3-year progression-free survival [PFS]: 25% vs. 76.7%, respectively; 3-year overall survival [OS]: 25% vs. 77.4%, respectively; P<0.001).

Conclusion: EBV-positive DLBCL of the elderly is associated with an inferior clinical course and inferior survival outcomes. The role of EBV in this disease and the optimal management of this subgroup warrants further investigation.

No MeSH data available.


Related in: MedlinePlus