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Ding X, Liang T, Liang B, Gao H, Wang J, Liu H, Wang F, Zheng X, Li P, Chen S, Feng E. Diagnostic value of EBV-DNA in CSF for PCNSL in AIDS patients with focal brain lesions: A meta-analysis of diagnostic test. Medicine (Baltimore) 2022; 101:e31793. [PMID: 36482588 PMCID: PMC9726345 DOI: 10.1097/md.0000000000031793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV) infection plays a crucial role in the progression of acquired immunodeficiency syndrome related primary central nervous system lymphoma (AR-PCNSL). This study aimed at evaluating the diagnostic value of cerebrospinal spinal fluid (CSF) EBV-deoxyribonucleic acid (DNA) for PCNSL in patients with infection of human immunodeficiency (HIV) virus through a meta-analysis of diagnostic test. METHODS A systematic search in PubMed, Embase, Web of Science, Wanfang, Chinese Biomedical Database and Chinese National Knowledge Infrastructure was conducted before May 10, 2022. Heterogeneity among the studies was assessed using Q test and I2 statistics. Publication bias was assessed using the Deek's funnel plot asymmetry test. Statistical analyses were performed using Stata 16.0 software. The pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR), diagnostic odds ratios (DOR) and 95% confidence intervals (CI) were caculated to evaluate the diagnostic value. A symmetric receiver operating characteristic (SROC) curve and the area under the SROC curve (AUC) were constructed to evaluate the test-performance. RESULTS Twelve studies were included in the final analyses, with a total of 141 patients with AR-PCNSL and 590 controls. The pooled diagnostic values were sensitivity of 0.83 (95% CI: 0.73-0.90), specificity of 0.95 (95%CI: 0.89-0.98), PLR of 17.8 (95%CI: 6.8-46.1), NLR of 0.17 (95%CI: 0.10-0.30), DOR of 102 (95%CI: 28-379), and AUC of 0.94 (95%CI: 0.91-0.96). CONCLUSION In summary the overall diagnostic value of CSF EBV-DNA is very high and it can be a reliable diagnostic biomarker for AR-PCNSL.
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Affiliation(s)
- Xinghuan Ding
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingyu Liang
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bo Liang
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Haili Gao
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jianbo Wang
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxing Liu
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fang Wang
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xinmei Zheng
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Peiliang Li
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shichao Chen
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Enshan Feng
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- National Center for Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Enshan Feng, Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China (e-mail: )
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Vishnevetsky A, Anand P. Approach to Neurologic Complications in the Immunocompromised Patient. Semin Neurol 2021; 41:554-571. [PMID: 34619781 DOI: 10.1055/s-0041-1733795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Neurologic complications are common in immunocompromised patients, including those with advanced human immunodeficiency virus, transplant recipients, and patients on immunomodulatory medications. In addition to the standard differential diagnosis, specific pathogens and other conditions unique to the immunocompromised state should be considered in the evaluation of neurologic complaints in this patient population. A thorough understanding of these considerations is critical to the inpatient neurologist in contemporary practice, as increasing numbers of patients are exposed to immunomodulatory therapies. In this review, we provide a chief complaint-based approach to the clinical presentations and diagnosis of both infectious and noninfectious complications particular to immunocompromised patients.
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Affiliation(s)
- Anastasia Vishnevetsky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pria Anand
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Abstract
Primary CNS lymphoma (PCNSL) has been designated an acquired immune deficiency syndrome (AIDS)-defining disease since 1983 and accounts for up to 15% of non-Hodgkin lymphomas in human immunodeficiency virus (HIV) patients. The majority of HIV patients are Epstein-Barr virus (EBV)-related. The most likely etiology is ineffective immunoregulation of EBV, inducing oncogenic protein expression, and subsequent loss of apoptosis and increased proliferation of lymphocytes. PCNSL generally presents with supratentorial, single or multiple, contrast-enhancing lesions. Neurologic symptoms can be headache, cognitive function disorders, focal neurologic, deficit and epilepsy. Differential diagnosis includes other oncologic or infectious causes, with cerebral toxoplasmosis being the most important. Magnetic resonance imaging characteristics, activity on 201thallium single-photon emission computed tomography, presence of EBV DNA in the cerebrospinal fluid, and toxoplasmosis serology can make either PCNSL or cerebral toxoplasmosis more or less likely. However, definitive diagnosis of PCNSL relies on histopathologic confirmation. First-choice treatment is combination antiretroviral therapy in combination with high-dose methotrexate(-based) chemotherapy in patients in whom this is feasible. Combination antiretroviral therapy combined with whole-brain radiotherapy may be an alternative. Treatment of EBV with antiviral agents such as ganciclovir or zidovudine may be beneficial, but this needs further study. Prognosis of HIV-related PCNSL is poor, with median survival varying from 2 to 4 months, but patients treated with chemotherapy do better (median survival 1.5 years).
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Affiliation(s)
- Dieta Brandsma
- Department of Neuro-Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jacoline E C Bromberg
- Department of Neuro-Oncology, Erasmus MC University Medical Center Cancer Center Daniel den Hoed, Rotterdam, The Netherlands.
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Hardee J, Ouyang Z, Zhang Y, Kundaje A, Lacroute P, Snyder M. STAT3 targets suggest mechanisms of aggressive tumorigenesis in diffuse large B-cell lymphoma. G3 (BETHESDA, MD.) 2013; 3:2173-85. [PMID: 24142927 PMCID: PMC3852380 DOI: 10.1534/g3.113.007674] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/05/2013] [Indexed: 01/02/2023]
Abstract
The signal transducer and activator of transcription 3 (STAT3) is a transcription factor that, when dysregulated, becomes a powerful oncogene found in many human cancers, including diffuse large B-cell lymphoma. Diffuse large B-cell lymphoma is the most common form of non-Hodgkin's lymphoma and has two major subtypes: germinal center B-cell-like and activated B-cell-like. Compared with the germinal center B-cell-like form, activated B-cell-like lymphomas respond much more poorly to current therapies and often exhibit overexpression or overactivation of STAT3. To investigate how STAT3 might contribute to this aggressive phenotype, we have integrated genome-wide studies of STAT3 DNA binding using chromatin immunoprecipitation-sequencing with whole-transcriptome profiling using RNA-sequencing. STAT3 binding sites are present near almost a third of all genes that differ in expression between the two subtypes, and examination of the affected genes identified previously undetected and clinically significant pathways downstream of STAT3 that drive oncogenesis. Novel treatments aimed at these pathways may increase the survivability of activated B-cell-like diffuse large B-cell lymphoma.
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Affiliation(s)
- Jennifer Hardee
- Department of Genetics, Stanford University School of Medicine, Stanford, California 94305
- Department of Molecular, Cellular, and Developmental Biology, Yale University, New Haven, Connecticut 06520
| | - Zhengqing Ouyang
- Department of Genetics, Stanford University School of Medicine, Stanford, California 94305
| | - Yuping Zhang
- Department of Genetics, Stanford University School of Medicine, Stanford, California 94305
| | - Anshul Kundaje
- Department of Genetics, Stanford University School of Medicine, Stanford, California 94305
- Department of Computer Science, Stanford University School of Engineering, Stanford, California 94305
| | - Philippe Lacroute
- Department of Genetics, Stanford University School of Medicine, Stanford, California 94305
| | - Michael Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California 94305
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5
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Pakpoor J, Giovannoni G, Ramagopalan SV. Epstein-Barr virus and multiple sclerosis: association or causation? Expert Rev Neurother 2013; 13:287-97. [PMID: 23448218 DOI: 10.1586/ern.13.6] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Multiple sclerosis (MS) is a multifactorial disease in which both genetic and environmental factors and their interactions underlie causation. The current evidence base supports a strong association between Epstein-Barr virus (EBV) and MS, but potential causality remains strongly debated. It is not possible to exclude the possibility that an abnormal response to EBV infection is a consequence, rather than a cause, of the underlying pathophysiology of MS, or indeed that the association may be a reflection of a similar underlying disease mechanism. Substantial experimental progress is necessary to achieve consistency of molecular findings to complement the strong epidemiological association between EBV and MS, which cannot alone show causation. Collectively, the strength of the association between EBV and MS warrants careful development and trial of anti-EBV drugs to observe any effect on MS disease course.
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Affiliation(s)
- Julia Pakpoor
- Department of Physiology, Anatomy and Genetics and Medical Research Council Functional Genomics Unit, University of Oxford, Oxford, UK
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Peker D, Alkan S, Zhang L, Martinez A. HIV-associated plasmablastic multicentric Castleman disease with microlymphoma coinfected with HHV8 and EBV. J Hematop 2012. [DOI: 10.1007/s12308-012-0156-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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7
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Raoux D, Duband S, Forest F, Trombert B, Chambonnière ML, Dumollard JM, Khaddage A, Gentil-Perret A, Péoc'h M. Primary central nervous system lymphoma: immunohistochemical profile and prognostic significance. Neuropathology 2009; 30:232-40. [PMID: 19925562 DOI: 10.1111/j.1440-1789.2009.01074.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare subtype of non-Hodgkin lymphoma (NHL) with extranodal location affecting only the CNS, meninges and eye, without visceral or lymph node involvement. Its incidence has increased sharply over the past three decades, especially in immunocompetent subjects. Most PCNSL cases are diffuse large B-cell lymphomas (DLBCLs). However, it differs from nodal DLBCL in that it has a worse prognosis. DLBCLs are a heterogeneous entity and according to new genomic discoveries, classifications into prognostic subgroups have been embarked upon. Two prognostic algorithms were then prepared using a panel of immunohistochemical markers (CD10, Bcl6, MUM1/IRF-4, and Bcl2), thus categorizing DLBCL into two subgroups, GCB (germinal centre B-cell-like) or non-GCB, and into Group 1 or Group 2. Our goal is to apply both of these two sub-classifications to 39 PCNSLs, in order to assess their usefulness and prognostic relevance. 74.3% of our PCNSLs were of a non-GCB phenotype, corresponding to an activated postgerminal origin. They were evenly distributed across G1 and G2. Two- and 5-year overall survival rates were 34.8% and 19.6%, respectively. Younger age (<65) and a therapeutic combination of chemotherapy and radiotherapy significantly improved our patients' survival rates. The other clinical or biological markers tested had no prognostic impact. The two classifications did not reveal any significant survival difference. The recent discovery of a specific "transcriptional signature" of PCNSL, marking them out of DLBCL could account for the irrelevance of such prognostic classifications to PCNSL.
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Affiliation(s)
- Delphine Raoux
- Department of Pathology, Centre, Hospitalier Universitaire de Saint-Etienne, Saint Etienne 42055 Cedex 2, France
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Beltran B, Salas R, Quiñones P, Morales D, Hurtado F, Cotrina E, Riva L, Castillo J. EBV-positive diffuse large B-cell lymphoma in a human T-lymphotropic virus type 1 carrier. Infect Agent Cancer 2009; 4:10. [PMID: 19580668 PMCID: PMC2713202 DOI: 10.1186/1750-9378-4-10] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 07/06/2009] [Indexed: 11/10/2022] Open
Abstract
The development of B-cell lymphomas has been seldom described in HTLV-1 carriers. We present the case of an elderly Peruvian HTLV-1 carrier who was diagnosed with EBV-positive diffuse large B-cell lymphoma. Despite an initial good response to therapy, patient died during treatment due to fatal Pneumocystis jirovecci pneumonia. EBV infection is characterized by B-cell lymphotropism and selective immunodeficiency. HTLV-1, on the other hand, induces T-cell dysfunction and B-cell proliferation. Finally, immunosenescence is characterized by T-cell dysregulation, decreased apoptosis and cytokine upregulation. In this elderly patient, the combination of EBV and HTLV-1 coinfection and immunosenescence may have played a role in the development of this aggressive diffuse large B-cell lymphoma. Furthermore, the immunodeficiency caused by the viral infections and chemotherapy may have played a role in developing life-threatening infectious complications.
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Affiliation(s)
- Brady Beltran
- The Warren Alpert Medical School of Brown University, Division of Hematology and Oncology, The Miriam Hospital, Providence, RI, USA.
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9
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Khorana AA, Rosenblatt JD, Young FM. Immunopathogenesis of HIV and HTLV-1 infection: mechanisms for lymphomagenesis. Cancer Treat Res 2001; 104:19-74. [PMID: 11191127 DOI: 10.1007/978-1-4615-1601-9_2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- A A Khorana
- Cancer Center and Hematology-Oncology Unit, University of Rochester Medical Center, Rochester, New York, USA
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10
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Abstract
With the introduction of the SA/Bi technology into the clinical diagnostic field ultrasensitive tests with an acceptable turn-around time became feasible. Cytokine ELISAs with lower detection limit in the picogram range became finally available. Prior to the introduction of SA/Bi only elevated levels of target could be detected by short time tests but not the normal base level. The turn around time for standard clinical immunological tests was reduced to 10-20 min from 2-4 h in old assays.
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Affiliation(s)
- H Schetters
- Roche Diagnostics GmbH, Labsystems R&D, Rare Reagents, Penzberg, Germany.
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11
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Nagashima T, Mori M, Kazumata K, Fujimoto M, Kuroda B, Nunomura M, Shinohara T, Hasegawa H, Watanabe Y, Tanaka S, Nagashima K. Meningeal large granular lymphocyte lymphoma. Neuropathology 1998. [DOI: 10.1111/j.1440-1789.1998.tb00124.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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