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Outcomes among North American patients with diffuse large B-cell lymphoma are independent of tumor Epstein-Barr virus positivity or immunosuppression.

Outcomes among North American patients with diffuse large B-cell lymphoma are independent of tumor Epstein-Barr virus positivity or immunosuppression.
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Tracy SI, Habermann TM, Feldman AL, Maurer MJ, Dogan A, Perepu US, Syrbu S, Ansell SM, Thompson CA, Weiner GJ, Nowakowski GS, Allmer C, Slager SL, Witzig TE, Cerhan JR, Link BK,


Tracy SI, Habermann TM, Feldman AL, Maurer MJ, Dogan A, Perepu US, Syrbu S, Ansell SM, Thompson CA, Weiner GJ, Nowakowski GS, Allmer C, Slager SL, Witzig TE, Cerhan JR, Link BK, (click to view)

Tracy SI, Habermann TM, Feldman AL, Maurer MJ, Dogan A, Perepu US, Syrbu S, Ansell SM, Thompson CA, Weiner GJ, Nowakowski GS, Allmer C, Slager SL, Witzig TE, Cerhan JR, Link BK,

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Haematologica 2017 11 23103(2) 297-303 doi 10.3324/haematol.2017.176511

Abstract

The prevalence, presenting clinical and pathological characteristics, and outcomes for patients with diffuse large B-cell lymphoma that is Epstein-Barr virus positive remain uncertain as does the impact of congenital or iatrogenic immunosuppression. Patients with newly diagnosed diffuse large B-cell lymphoma with available tissue arrays were identified from the University of Iowa/Mayo Clinic Molecular Epidemiology Resource. Patients infected with human immunodeficiency virus or who had undergone a prior organ transplant were excluded. Epstein-Barr virus-associated ribonucleic acid testing was performed on all tissue arrays. A history of significant congenital or iatrogenic immunosuppression was determined for all patients. At enrollment, 16 of the 362 (4.4%) biopsies were positive for Epstein-Barr virus. Thirty-nine (10.8%) patients had a significant history of immunosuppression. Patients with Epstein-Barr-positive diffuse large B-cell lymphoma had no unique clinical characteristics but on pathology exhibited a higher frequency of CD30 positivity (25.0% versus 8.1%, respectively; P<0.01), and non-germinal-center subtype (62.5% versus 34.1%, respectively; P<0.01). No baseline clinical characteristics were associated with a history of immunosuppression. With a median follow up of 59 months, and after adjustment for International Prognostic Index, there was no association of Epstein-Barr virus positivity or immunosuppression with event-free survival at 24 months (odds ratio=0.49; 95% confidence interval: 0.13-1.84 and odds ratio=0.81; 95% confidence interval: 0.37-1.77) or overall survival (hazard ratio=0.86; 95% confidence interval: 0.38-1.97 and hazard ratio=1.00; 95% confidence interval: 0.57-1.74). In contrast to non-Western populations, our North American population had a low prevalence of Epstein-Barr virus-positive diffuse large B-cell lymphoma that did not convey an adverse prognosis. A history of immunosuppression, while known to be a risk factor for the development of diffuse large B-cell lymphoma, did not affect subsequent prognosis.

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