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Hu J, Zhang X, Tao H, Jia Y. The prognostic value of Epstein-Barr virus infection in Hodgkin lymphoma: A systematic review and meta-analysis. Front Oncol 2022; 12:1034398. [PMID: 36387159 PMCID: PMC9648611 DOI: 10.3389/fonc.2022.1034398] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Epstein-Barr virus (EBV) contributes significantly to the development and occurrence of B-cell lymphomas. However, the association between EBV infection status and clinical outcomes in Hodgkin lymphoma (HL) patients has long been controversial. Therefore, we aimed to estimate the prognostic significance of EBV infection in HL survival. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library for relevant cohort studies from the date of their inception to February 20, 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS), Failure-free survival (FFS), Progression-free survival (PFS), Event-free survival (EFS) and disease-specific survival (DSS) were extracted from the studies or calculated. Subgroup analyses were conducted independently on the five survival outcomes to investigate the source of heterogeneity. RESULTS A total of 42 qualified studies involving 9570 patients were identified in our meta-analysis. There was an association between EBV positivity and significantly poorer OS (HR=1.443, 95% CI: 1.250-1.666) and DSS (HR=2.312, 95% CI: 1.799-2.972). However, the presence of EBV in HL showed no effect on FFS, PFS or EFS. In subgroup analyses of OS, DSS and FFS stratified by age groups, EBV positivity was associated with poorer prognosis in elderly patients. Meanwhile, in children and adolescents with EBV-positive HL, we also observed a trend toward a better prognosis, though the results were not statistically significant. CONCLUSIONS EBV-positive status is associated with poor OS and DSS in HL patients. EBV infection should therefore be considered a valuable prognostic marker and risk-stratifying factor in HL, especially in older patients. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022328708.
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Affiliation(s)
| | | | | | - Yongqian Jia
- Department of Hematology, West China Hospital, Sichuan University, Chengdu, China
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2
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Impact of Tumour Epstein–Barr Virus Status on Clinical Outcome in Patients with Classical Hodgkin Lymphoma (cHL): A Review of the Literature and Analysis of a Clinical Trial Cohort of Children with cHL. Cancers (Basel) 2022; 14:cancers14174297. [PMID: 36077832 PMCID: PMC9454639 DOI: 10.3390/cancers14174297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The Epstein–Barr virus (EBV) contributes to different forms of human cancer, including a subset of classical Hodgkin lymphoma (cHL), a B-cell lymphoma with unusual histological features. Although the pathogenesis of EBV-associated cHL remains to be elucidated, biological investigations point to an important aetiological role for the virus in the development of this tumour. This is even more relevant now considering the potential opportunities that exist to treat EBV-associated disorders, for example, with immunotherapeutics or small molecule inhibitors targeting viral proteins. For this reason, we believe it is now timely to review the association between EBV and cHL and in particular to re-evaluate the impact of EBV status on clinical outcomes in cHL patients. Herein, we also report the impact of EBV on clinical outcomes in a cohort of children and adolescents with cHL. Abstract In this study, we have re-evaluated how EBV status influences clinical outcome. To accomplish this, we performed a literature review of all studies that have reported the effect of EBV status on patient outcome and also explored the effect of EBV positivity on outcome in a clinical trial of children with cHL from the UK. Our literature review revealed that almost all studies of older adults/elderly patients have reported an adverse effect of an EBV-positive status on outcome. In younger adults with cHL, EBV-positive status was either associated with a moderate beneficial effect or no effect, and the results in children and adolescents were conflicting. Our own analysis of a series of 166 children with cHL revealed no difference in overall survival between EBV-positive and EBV-negative groups (p = 0.942, log rank test). However, EBV-positive subjects had significantly longer event-free survival (p = 0.0026). Positive latent membrane protein 1 (LMP1) status was associated with a significantly lower risk of treatment failure in a Cox regression model (HR = 0.21, p = 0.005). In models that controlled for age, gender, and stage, EBV status had a similar effect size and statistical significance. This study highlights the age-related impact of EBV status on outcome in cHL patients and suggests different pathogenic effects of EBV at different stages of life.
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Biggi AFB, Elgui de Oliveira D. The Epstein-Barr Virus Hacks Immune Checkpoints: Evidence and Consequences for Lymphoproliferative Disorders and Cancers. Biomolecules 2022; 12:biom12030397. [PMID: 35327589 PMCID: PMC8946074 DOI: 10.3390/biom12030397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 12/12/2022] Open
Abstract
The Epstein-Barr Virus (EBV) is a gammaherpesvirus involved in the etiopathogenesis of a variety of human cancers, mostly of lymphoid and epithelial origin. The EBV infection participates in both cell transformation and tumor progression, also playing an important role in subverting immune responses against cancers. The homeostasis of the immune system is tightly regulated by inhibitory mechanisms affecting key immune effectors, such as T lymphocytes and NK cells. Collectively known as immune checkpoints, these mechanisms rely on a set of cellular receptors and ligands. These molecules may be candidate targets for immune checkpoints blockade—an emergent and promising modality of immunotherapy already proven to be valuable for a variety of human cancers. The EBV was lately suspected to interfere with the expression of immune checkpoint molecules, notably PD-1 and its ligands, found to be overexpressed in cases of Hodgkin lymphoma, nasopharyngeal, and gastric adenocarcinomas associated with the viral infection. Even though there is compelling evidence showing that the EBV interferes with other immune checkpoint regulators (e.g., CTLA-4, LAG-3, TIM-3, and VISTA), the published data are still scarce. Herein, we discuss the current state of the knowledge on how the EBV interferes with the activity of immune checkpoints regulators, as well as its implications considering the immune checkpoints blockade for clinical management of the EBV-associated malignancies, notably lymphomas.
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Affiliation(s)
| | - Deilson Elgui de Oliveira
- Department of Pathology, Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil
- ViriCan, Institute for Biotechnology (IBTEC), São Paulo State University (UNESP), Botucatu 18607-440, SP, Brazil
- Correspondence: ; Tel.: +55-14-3880-1573
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Kotaki R, Kawashima M, Yamamoto Y, Higuchi H, Nagashima E, Kurosaki N, Takamatsu M, Kikuti YY, Imadome KI, Nakamura N, Kotani A. Dasatinib exacerbates splenomegaly of mice inoculated with Epstein-Barr virus-infected lymphoblastoid cell lines. Sci Rep 2020; 10:4355. [PMID: 32152351 PMCID: PMC7062761 DOI: 10.1038/s41598-020-61300-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/17/2020] [Indexed: 12/25/2022] Open
Abstract
Latent infection of Epstein-Barr virus (EBV) is associated with a poor prognosis in patients with B cell malignancy. We examined whether dasatinib, a multi kinase inhibitor, which is broadly used for chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia is effective on EBV-positive B cell malignancies, using lymphoblastoid cell lines (LCLs) in vitro and in vivo. As a result, in vitro experiments showed that dasatinib induced cell death of the EBV-LCLs which was not accompanied with a lytic reactivation of EBVs. To evaluate the effectiveness in EBV latency type III represented by immunodeficiency lymphoma, LCL-inoculated immunodeficient NOD/shi-scid/Il2rgnul (NOG) mice were treated with dasatinib. However, in vivo experiments revealed that dasatinib treatment exacerbated tumor cell infiltration into the spleen of LCL-inoculated NOG mice, whereas tumor size at the inoculated site was not affected by the treatment. These results suggest that dasatinib exacerbates the pathogenesis at least in some situations although the drug is effective in vitro. Hence, we should carefully examine a possibility of dasatinib repositioning for EBV+ B cell malignancies.
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Affiliation(s)
- Ryutaro Kotaki
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan
| | - Masaharu Kawashima
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan.,Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuichiro Yamamoto
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan
| | - Hiroshi Higuchi
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan.,Research Institute of Science and Technology, Tokai University, 4-1-1 Kitakinme, Hiratsuka, Kanagawa, Japan
| | - Etsuko Nagashima
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan
| | - Natsumi Kurosaki
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan
| | - Masako Takamatsu
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan
| | - Yara Yukie Kikuti
- Department of Pathology, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, Japan
| | - Ken-Ichi Imadome
- Department of Infectious Diseases, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, Japan
| | - Ai Kotani
- Department of Hematological Malignancy, Institute of Medical Science, Tokai University, Shimokasuya 143, Isehara, Kanagawa, Japan. .,Precursory Research for Embryonic Science and Technology, Japan Science and Technology Agency, Saitama, Japan. .,AMED-PRIME, Japan Agency for Medical Research and Development, Tokyo, Japan.
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5
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Lee WJ, Won KH, Choi JW, Won CH, Chang SE, Choi JH, Lee MW. Cutaneous angioimmunoblastic T-cell lymphoma: Epstein-Barr virus positivity and its effects on clinicopathologic features. J Am Acad Dermatol 2019; 81:989-997. [DOI: 10.1016/j.jaad.2018.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/22/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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Yotsumoto M, Ito Y, Hagiwara S, Terui Y, Nagai H, Ota Y, Ajisawa A, Uehira T, Tanuma J, Ohyashiki K, Okada S. HIV positivity may not have a negative impact on survival in Epstein-Barr virus-positive Hodgkin lymphoma: A Japanese nationwide retrospective survey. Oncol Lett 2018; 16:3923-3928. [PMID: 30128009 DOI: 10.3892/ol.2018.9132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/24/2018] [Indexed: 02/06/2023] Open
Abstract
There has been no comparative clinical study focused on differences in the clinical features of Epstein-Barr virus (EBV)+ Hodgkin lymphoma (HL) between HIV-positive and -negative cases. In a nationwide survey from 511 institutions in Japan, the present study investigated 16 EBV+ HIVpositive HL patients. To further clarify their characteristics in comparison with EBV+ HIVnegative HL (n=34) in the combination antiretroviral therapy era in Japan, the present study was performed. Results indicated that EBV+ HIVpositive HL frequently occurred in a younger population compared with EBV+ HIVnegative HL (P=0.0295), and that the EBV+ HIVpositive HL group was not associated with the nodular sclerosis subtype in the population who were below the age of 40. Notably, the EBV+ HIVpositive HL group had a significantly higher frequency of extra-nodal involvement (P=0.0214), including marrow invasion. In the advanced stage, 80% of those with EBV+ HIVpositive HL did not require dose-reduction and in the majority of cases, chemotherapy was completed. There were no significant differences in the complete remission rate (P=0.1961), overall survival (P=0.200) and progression-free survival (P=0.245) between EBV+ HIVpositive HL (median observational period, 23.5 months) and EBV+ HIVnegative HL (median observational period, 64.5 months), suggesting that HIV positivity may not have a negative impact on the clinical outcome of EBV+ HL. Notably, standard chemotherapy is effective and tolerable for EBV+ HL, regardless of HIV infection.
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Affiliation(s)
- Mihoko Yotsumoto
- Department of Laboratory Medicine, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Yoshikazu Ito
- Department of Hematology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Shotaro Hagiwara
- Department of Hematology, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Yasuhito Terui
- Department of Hematology Oncology, Cancer Institute Hospital of JFCR, Koto-ku, Tokyo 135-8550, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya-shi, Aichi 460-0001, Japan
| | - Yasunori Ota
- Department of Pathology, Teikyo University Hospital, Minato-ku, Tokyo 173-0003, Japan
| | - Atsushi Ajisawa
- Department of Infectious Diseases, Tokyo Metropolitan Toshima Hospital, Itabashi-ku, Tokyo 173-0015, Japan
| | - Tomoko Uehira
- Department of Infectious Diseases, National Hospital Organization Osaka National Hospital, Chuo-ku, Osaka 540-0006, Japan
| | - Junko Tanuma
- AIDS Clinical Center, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo 162-8655, Japan
| | - Kazuma Ohyashiki
- Department of Hematology, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Seiji Okada
- Division of Hematopoiesis, Center for AIDS Research, Kumamoto University, Chuo-ku, Kumamoto 860-8556, Japan
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Koh YW, Han JH, Yoon DH, Suh C, Huh J. Epstein-Barr virus positivity is associated with angiogenesis in, and poorer survival of, patients receiving standard treatment for classical Hodgkin's lymphoma. Hematol Oncol 2017; 36:182-188. [DOI: 10.1002/hon.2468] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Young Wha Koh
- Department of Pathology; Ajou University School of Medicine; Suwon Korea
| | - Jae-Ho Han
- Department of Pathology; Ajou University School of Medicine; Suwon Korea
| | - Dok Hyun Yoon
- Departments of Oncology; University of Ulsan College of Medicine; Seoul Korea
| | - Cheolwon Suh
- Departments of Oncology; University of Ulsan College of Medicine; Seoul Korea
| | - Jooryung Huh
- Pathology, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
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8
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Myriam BD, Sonia Z, Hanene S, Teheni L, Mounir T. Prognostic significance of Epstein-Barr virus (EBV) infection in Hodgkin lymphoma patients. J Infect Chemother 2016; 23:121-130. [PMID: 28034523 DOI: 10.1016/j.jiac.2016.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The prognostic significance of Epstein-Barr virus (EBV) infection in Hodgkin lymphoma (HL) is still controversial. In this work we sought to examine the prognostic differences between EBV-positive and -negative HL through a series of 131 cases from Tunisia. METHODS The status of EBV was assessed by EBV-encoded RNA (EBER) in situ hybridization. Results were correlated to patients' characteristics and outcome. RESULTS EBV was detected in the malignant cells in 62 of 131 HL cases (47.3%). EBV-positive HL was associated with extreme age classes (≤15 and > 45 years; p = 0.0001), male gender (p = 0.008), mixed cellularity histologic subtype (p = 0.03), and inversely with leukocytosis (white blood cells ≥15000/mm3) (p = 0.004) and bulky mediastinum (mediastinal-thoracic ratio≥ 0.35) (p = 0.0001). On analysis of all patients, no significant difference between survival rates was found between EBV-positive and EBV-negative HL. In contrast, subgroups analysis revealed a negative effect of EBV infection in terms of overall survival in patients with Ann Arbor stages I/II (p = 0.03) and nodular sclerosis HL subgroup (p = 0.01), and in terms of event free survival in patients with mediastinal-thoracic ratio less than 0.35 (p = 0.03). CONCLUSION These results suggest that EBV infection affects the survival of particular subgroups of HL, especially those with early-stage of the disease.
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Affiliation(s)
- Ben Dhiab Myriam
- Department of Pathology, University Hospital Farhat-Hached, Sousse 4000, Tunisia
| | - Ziadi Sonia
- Department of Pathology, University Hospital Farhat-Hached, Sousse 4000, Tunisia
| | - Saad Hanene
- Department of Pathology, University Hospital Farhat-Hached, Sousse 4000, Tunisia
| | - Louhichi Teheni
- Department of Pathology, University Hospital Farhat-Hached, Sousse 4000, Tunisia
| | - Trimeche Mounir
- Department of Pathology, University Hospital Farhat-Hached, Sousse 4000, Tunisia.
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Shi YF, Gao ZF, Liu CL, Li M, Lin DM, Zhou LX, Lai YM, Liu XL, Huang X. [TNFAIP3 deletion status in classical Hodgkin lymphoma and its relation to Epstein-Barr virus]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:1060-1064. [PMID: 28088970 PMCID: PMC7348485 DOI: 10.3760/cma.j.issn.0253-2727.2016.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Indexed: 11/29/2022]
Abstract
Objective: To investigate the TNFAIP3/A20 abnormalities and its association with Epstein-Barr virus (EBV) in classical Hodgkin lymphoma (CHL). Methods: Formalin-fixed, paraffinembedded tissue blocks of 54 CHL patients were collected and subjected to the construction of tissue microarray (TMA) for further analyses. EBV status was evaluated by in situ hybridization (ISH) for EBER1/2 and immunohistochemistry (IHC) with anti-LMP-1 antibody. Fluorescence in situ hybridization (FISH) and IHC were performed to determine the copy number alterations of TNFAIP3 and A20 protein expression respectively. Results: The concordance rate of IHC for LMP-1 and ISH for EBER1/2 was100%, and 25.9% (14/54) cases were identified with EBV infection. Immunohistochemistry analysis demonstrated 27.8% (15/54) cases with A20 expression deficiency. Of the 54 cases tested for A20 expression, 49 cases were simultaneously analyzed by FISH, which showed 10 (20.4% ) cases harboring TNFAIP3 deletion. However, discrepancy was observed between the results of A20 by IHC and TNFAIP3 deletion by FISH. Only 1 case with TNFAIP3 deletion demonstrated complete loss of A20 immunoreactivity. In addition, comparison of the frequency of either A20 expression loss or TNFAIP3 deletion between EBV-positive and-negative cases did not reveal any significance (P>0.05). Conclusion: TNFAIP3 deletion could be observed in both EBV-positive and - negative CHL cases. A20 expression by IHC could not confirm TNFAIP3 deletion by FISH, which might be related to the technical issues.
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Affiliation(s)
| | | | | | | | | | | | | | | | - X Huang
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
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Park JH, Yoon DH, Kim S, Park JS, Park CS, Sung H, Lee SW, Huh J, Suh C. Pretreatment whole blood Epstein-Barr virus-DNA is a significant prognostic marker in patients with Hodgkin lymphoma. Ann Hematol 2016; 95:801-8. [PMID: 26883027 DOI: 10.1007/s00277-016-2610-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
Abstract
Epstein-Barr virus (EBV) in the peripheral blood has become a significant predictor of clinical outcomes in EBV-associated Hodgkin lymphoma (HL). However, due to its relative rarity, prevalence and prognostic role of circulating EBV-DNA has not been well established in Asian patients. Seventy patients with newly diagnosed HL were prospectively registered between October 2007 and January 2013, and underwent pretreatment whole blood (WB) EBV-DNA quantitation using real-time polymerase chain reaction (RT-PCR). WB EBV-DNA in baseline and serial RT-PCR within 1 year were investigated. Clinicopathologic parameters of the patients according to pretreatment WB EBV-DNA were also explored. Twelve patients (17.1 %) demonstrated WB EBV-DNA(+), which was significantly associated to older age, advanced stages, frequent involvements of extranodal sites, low serum albumin and hemoglobin levels, and high international prognostic scores ≥2. Three-year event-free survival (EFS) and overall survival (OS) were significantly inferior in patients with pretreatment WB EBV-DNA(+) (53.5 vs 67.0 and 65.6 vs 90.2 %) (p < 0.032 and <0.01). Negatively conversed EBV-DNA within 1 year after chemotherapy also significantly affected favorable EFS (p < 0.01). Taken together, pretreatment WB EBV-DNA(+) may be a significant predictor of inferior EFS and OS over EBV-encoded RNA in situ hybridization (EBER-ISH)(+) in Korean patients with HL. Serial EBV-DNA monitoring following chemotherapy also seems helpful to predict survival outcomes.
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Affiliation(s)
- Ji Hyun Park
- Department of Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Jung Sun Park
- Department of Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
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Tanyildiz HG, Yildiz I, Bassullu N, Tuzuner N, Ozkan A, Celkan T, Apak H. The Role of Epstein-Barr Virus LMP-1 Immunohistochemical Staining in Childhood Hodgkin Lymphoma. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e2359. [PMID: 26635935 PMCID: PMC4662835 DOI: 10.5812/ijp.2359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/07/2015] [Accepted: 09/20/2015] [Indexed: 11/17/2022]
Abstract
Background: There are a few published studies about prognostic markers of Epstein-B virus (EBV) related to outcomes in pediatric Hodgkin Lymphoma (HL). Objectives: We aimed to investigate the prognostic value and effect of EBV on survival by using biopsy materials in children and adolescents diagnosed with HL. Patients and Methods: EBV LMP-1 expression was examined using immunohistochemical methods in 58 tumor samples. Clinical features, overall survival (OS) and failure free survival time (FFS) were compared between EBV LMP-1 positive and negative patients. Results: In 20 (35%) patients tumors were LMP-1 positive. When compared with patients above 10 years old, EBV LMP-1 was often positive in patients under 10 years old (30% vs. 70%, P = 0.02). In our most cases having B symptoms and advanced stage, EBV positiveness in Hodgkin Reed-Stenberg cells (H-RS) was not a significant determinant for survival (P = 0.78). Half of the past clinical trials in childhood HL reported longer survival rates in EBV LMP-1 positive patients. In some trials similar to our results there was no significant relationship between EBV and prognosis. Conclusions: The reason of diminished EBV positiviness may be related to technical methods such as not using immunohistochemical and in situ hybridization for EBER antigen but in laboratory conditions painting of control tissues with EBV impair this probability. In addition, cases enrolled to our study were living in Istanbul where social and economical factors are improved rather than generally.
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Affiliation(s)
- Hikmet Gulsah Tanyildiz
- Department of Pediatric Hematology/Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
- Corresponding author: Hikmet Gulsah Tanyildiz, Department of Pediatric Hematology/Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. Tel: +90-5058731636; +90-3123056182, E-mail:
| | - Inci Yildiz
- Department of Pediatric Hematology/Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nuray Bassullu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nukhet Tuzuner
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Alp Ozkan
- Department of Pediatric Hematology/Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Tiraje Celkan
- Department of Pediatric Hematology/Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hilmi Apak
- Department of Pediatric Hematology/Oncology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Elsayed AA, Asano N, Ohshima K, Izutsu K, Kinoshita T, Nakamura S. Prognostic significance of CD20 expression and Epstein-Barr virus (EBV) association in classical Hodgkin lymphoma in Japan: a clinicopathologic study. Pathol Int 2015; 64:336-45. [PMID: 25047504 DOI: 10.1111/pin.12175] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/28/2014] [Indexed: 01/07/2023]
Abstract
To investigate the clinicopathological significance of CD20 expression and Epstein-Barr virus (EBV) association in Hodgkin and Reed-Sterberg cells of classical Hodgkin lymphoma (CHL), CD20 expression and EBV positivity (by EBER in situ hybridization) were investigated in 389 CHL patients in Japan. They included 74 CD20-positive cases (19%) and 315 CD20-negative cases (81%). CD20-positive cases showed significantly older age at onset (P = 0.018) and higher association with EBV (P = 0.002). Multivariate analysis identified EBV-positivity (but not CD20-positivity), presence of B symptoms, thrombocytopenia, elevated serum lactate dehydrogenase and performance status >1 as poor prognostic factors for overall survival (OS). We constructed a new prognostic model with these five factors classifying patients into three groups: low risk, 0-1 adverse factor; intermediate risk, 2-3 factors; high risk, 4-5 factors. This prognostic model could stratify the prognosis of CHL patients (P < 0.0001). For 144 patients (58%) classified into the low-risk group, the 5-year OS was 91%. For 92 patients (37%) in the intermediate group, the 5-year OS was 66%; for 11 patients (5%) in the high-risk group, the 5-year OS was 36%. In conclusion, EBV is identified as an independent poor prognostic factor for CHL patients. Therefore, examination of EBV association in CHL is recommended as routine pathologic practice especially in countries where EBV infection prevails.
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Affiliation(s)
- Ahmed Ali Elsayed
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan; Department of Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Pratesi C, Zanussi S, Tedeschi R, Bortolin MT, Talamini R, Rupolo M, Scaini C, Basaglia G, Di Maso M, Mazzucato M, Zanet E, Tirelli U, Michieli M, Carbone A, De Paoli P. γ-Herpesvirus load as surrogate marker of early death in HIV-1 lymphoma patients submitted to high dose chemotherapy and autologous peripheral blood stem cell transplantation. PLoS One 2015; 10:e0116887. [PMID: 25668032 PMCID: PMC4323102 DOI: 10.1371/journal.pone.0116887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 12/16/2014] [Indexed: 12/13/2022] Open
Abstract
Autologous stem cell transplantation (ASCT) is a feasible procedure for human immunodeficiency virus-1 (HIV-1) lymphoma patients, whose underlying disease and intrinsic HIV-1- and ASCT-associated immunodeficiency might increase the risk for γ-herpesvirus load persistence and/or reactivation. We evaluated this hypothesis by investigating the levels of Epstein-Barr virus (EBV)- and Kaposi sarcoma-associated herpesvirus (KSHV)-DNA levels in the peripheral blood of 22 HIV-1-associated lymphoma patients during ASCT, highlighting their relationship with γ-herpesvirus lymphoma status, immunological parameters, and clinical events. EBV-DNA was detected in the pre-treatment plasma and peripheral blood mononuclear cells (PBMCs) of 12 (median 12135 copies/mL) and 18 patients (median 417 copies/106 PBMCs), respectively; the values in the two compartments were correlated (r = 0.77, p = 0.0001). Only EBV-positive lymphomas showed detectable levels of plasma EBV-DNA. After debulking chemotherapy, plasma EBV-DNA was associated with lymphoma chemosensitivity (p = 0.03) and a significant higher mortality risk by multivariate Cox analysis adjusted for EBV-lymphoma status (HR, 10.46, 95% CI, 1.11–98.32, p = 0.04). After infusion, EBV-DNA was detectable in five EBV-positive lymphoma patients who died within six months. KSHV-DNA load was positive in only one patient, who died from primary effusion lymphoma. Fluctuations in levels of KSHV-DNA reflected the patient’s therapy and evolution of his underlying lymphoma. Other γ-herpesvirus-associated malignancies, such as multicentric Castleman disease and Kaposi sarcoma, or end-organ complications after salvage treatment were not found. Overall, these findings suggest a prognostic and predictive value of EBV-DNA and KSHV-DNA, the monitoring of which could be a simple, complementary tool for the management of γ-herpesvirus-positive lymphomas in HIV-1 patients submitted to ASCT.
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Affiliation(s)
- Chiara Pratesi
- Microbiology, Immunology and Virology Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Stefania Zanussi
- Microbiology, Immunology and Virology Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
- * E-mail:
| | - Rosamaria Tedeschi
- Microbiology, Immunology and Virology Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Maria Teresa Bortolin
- Microbiology, Immunology and Virology Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Renato Talamini
- Epidemiology and Biostatistics Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Maurizio Rupolo
- Cellular Therapy and High-Dose Chemotherapy Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Chiara Scaini
- Microbiology, Immunology and Virology Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Giancarlo Basaglia
- Microbiology, Immunology and Virology Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Matteo Di Maso
- Epidemiology and Biostatistics Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Mario Mazzucato
- Stem Cell Collection and Processing Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Ernesto Zanet
- Cellular Therapy and High-Dose Chemotherapy Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Umberto Tirelli
- Division of Medical Oncology A, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Mariagrazia Michieli
- Cellular Therapy and High-Dose Chemotherapy Unit, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Antonino Carbone
- Department of Pathology, CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
| | - Paolo De Paoli
- Scientific Directorate; CRO National Cancer Institute, IRCCS, Aviano, Pordenone, Italy
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Prevalence and Prognostic Significance of Epstein–Barr Virus Infection in Classical Hodgkin's Lymphoma: A Meta-analysis. Arch Med Res 2014; 45:417-31. [DOI: 10.1016/j.arcmed.2014.06.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/04/2014] [Indexed: 12/21/2022]
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15
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Choe JY, Yun JY, Jeon YK, Kim SH, Park G, Huh JR, Oh S, Kim JE. Indoleamine 2,3-dioxygenase (IDO) is frequently expressed in stromal cells of Hodgkin lymphoma and is associated with adverse clinical features: a retrospective cohort study. BMC Cancer 2014; 14:335. [PMID: 24886161 PMCID: PMC4026588 DOI: 10.1186/1471-2407-14-335] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 05/02/2014] [Indexed: 01/07/2023] Open
Abstract
Background Regulation of tumor microenvironment is closely involved in the prognosis of Hodgkin lymphoma (HL). Indoleamine 2,3-dioxygenase (IDO) is an enzyme acting as immune modulator through suppression of T-cell immunity. This study aims to investigate role of IDO in the microenvironment of HL. Methods A total of 121 cases of HL were enrolled to do immunohistochemistry for IDO, CD163, CD68, CD4, CD8, and FoxP3. Positivity was evaluated from area fractions or numbers of positive cells using automated image analyzer. Correlations between IDO expression and various cellular infiltrates and clinicopathologic parameters were examined and survival analyses were performed. Results IDO was expressed in histiocytes, dendritic cells and some endothelial cells with variable degrees, but not in tumor cells. IDO positive cells were more frequently found in mixed cellularity type than other histologic types, and in cases with EBV+, high Ann Arbor stages, B symptoms, and high IPS (all p < 0.05). High IDO expression was associated with inferior survival (p < 0.001) and reflects an independent prognostic factor in nodular sclerosis HL. Conclusions This is the first study suggesting that IDO is the principle immunomodulator and is involved to adverse clinical outcomes of HL.
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Affiliation(s)
| | | | | | | | | | | | | | - Ji Eun Kim
- Department of Pathology, Seoul National University Boramae Hospital, Seoul, Korea.
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16
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Koh YW, Park CS, Yoon DH, Suh C, Huh J. CD163 expression was associated with angiogenesis and shortened survival in patients with uniformly treated classical Hodgkin lymphoma. PLoS One 2014; 9:e87066. [PMID: 24489836 PMCID: PMC3906082 DOI: 10.1371/journal.pone.0087066] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/22/2013] [Indexed: 12/12/2022] Open
Abstract
Background Recent studies have reported the prognostic value of tissue-associated magrophages (TAMs) in classical Hodgkin lymphoma (cHL). In addition, TAMs are implicated in the tumor angiogenesis. In this study, we examined the prognostic relevance of TAMs in relation to vascular endothelial growth factor (VEGF) expression and angiogenesis in uniformly treated cases of cHL. Methods Diagnostic tissue from 116 patients with ABVD-treated cHL was evaluated retrospectively by immunohistochemical analysis for CD68, CD163 and VEGF expression and for CD31 expression as a measure of microvessel density (MVD). Results High CD163 expression (≥35% of cellularity) correlated with VEGF expression (Pearson’s Chi-square test, P = 0.008) and MVD (Spearman correlation coefficient 0.310, P<0.001). High CD163 expression was associated with inferior event-free survival (EFS, P = 0.005) and overall survival (OS, P<0.001) in univariate analysis. In multivariate analysis, high CD163 expression was strongly associated with inferior EFS (P = 0.043) and OS (P = 0.008). Patients with high MVD had a lower OS than those with low MVD, but the difference was not significant (P = 0.071, respectively). While high expression of CD68 was also associated with inferior EFS (P = 0.007), it showed no correlation with VEGF or MVD. Conclusions Our data confirms that CD163 expression provides independent prognostic information in cHL. The correlation of CD163 with VEGF expression and MVD suggests the role of CD163-positive cells in tumor angiogenesis of cHL.
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Affiliation(s)
- Young Wha Koh
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- * E-mail:
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MET and MST1R as prognostic factors for classical Hodgkin's lymphoma. Mod Pathol 2013; 26:1172-82. [PMID: 23558571 DOI: 10.1038/modpathol.2013.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 11/06/2012] [Accepted: 01/10/2013] [Indexed: 01/18/2023]
Abstract
MST1R (RON) and MET are receptor tyrosine kinase gene family members that form a noncovalent complex on the cell surface, a critical step in tumor progression. A recent study suggested a prognostic role of MET expression in Hodgkin/Reed-Sternberg (HRS) cells in classical Hodgkin's lymphoma (cHL). The purpose of this study was to examine the prognostic significance of MET and MST1R expression in cHL. The prognostic impact of MET and MST1R was examined in 100 patients with cHL (median age: 32 years) by immunohistochemistry and mRNA in situ hybridization. The median follow-up time was 95 months (interquartile range: 42-126 months). MET or MST1R protein expression was associated with high MET or MST1R mRNA expression, respectively. Thirty-eight patients (38%) expressed MET protein in HRS cell, which was associated with better overall survival (P=0.004). Twenty-six patients (26%) expressed MST1R protein, which was associated with better overall survival (P=0.022) and event-free survival (P=0.021). Multivariate analysis identified MET protein as an independent prognostic factor for overall survival and MST1R protein as an independent prognostic factor for event-free survival. Subgroup analysis according to Ann Arbor stage showed that expressions of MET and MST1R protein have prognostic impact in the advanced stage only. In particular, coexpression of MST1R and MET protein was associated with a better survival outcome than MET or MST1R expression alone or no expression. This study suggests that MET and MST1R are independent prognostic factors in classical cHL, and may allow the identification of a subgroup of cHL patients who require more intensive therapy.
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Prognostic Significance of COX-2 Expression and Correlation With Bcl-2 and VEGF Expression, Microvessel Density, and Clinical Variables in Classical Hodgkin Lymphoma. Am J Surg Pathol 2013; 37:1242-51. [DOI: 10.1097/pas.0b013e31828b6ad3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Changing trend of Epstein-Barr virus association in Hodgkin lymphoma in the Republic of Korea. Ann Hematol 2013; 92:1653-60. [PMID: 23832190 DOI: 10.1007/s00277-013-1837-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 06/23/2013] [Indexed: 10/26/2022]
Abstract
Hodgkin lymphoma (HL) in resource-poor population shows an early childhood peak with predominance of mixed cellularity (MCHL) and high Epstein-Barr virus (EBV) association, whereas HL in resource-rich population has a peak in ages 15-29 years with the predominance of nodular sclerosis (NSHL) and low EBV association. We examined the changing trend of HL in association with EBV in Korea in 385 cases of HL (1980-2011). Data from 1980-1995 and 1996-2011 were compared. Age distribution showed a marked decrease in children (age < 15 years) (21.0 % to 8.6 %, p = 0.004) and sharp increase in young adults (ages 15-29 years) and ages 30-59 years. Male predominance decreased from 3.04 to 1.57. Predominant subtype changed from MCHL to NSHL; MCHL fell from 53.3 % to 26.4 % (p < 0.001), and NSHL rose from 24.8 % to 58.2 % (p < 0.001). EBV-positive HL decreased from 66.7 % to 38.2 %. However, in young adult females, EBV positive cases increased, contributing to the peak in this age group. Epidemiology of HL in Korea is rapidly changing into a Western pattern concurrent with the socioeconomic changes. Analysis of the cases stratified by EBV status and sex identified a smaller hidden peak in the young adult age, which confirms the four disease hypothesis proposed by Jarrett. We propose EBV testing as an essential component in epidemiologic study of Hodgkin lymphoma.
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Huh J. Epidemiologic overview of malignant lymphoma. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:92-104. [PMID: 22783355 PMCID: PMC3389073 DOI: 10.5045/kjh.2012.47.2.92] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 06/08/2012] [Accepted: 06/13/2012] [Indexed: 12/19/2022]
Abstract
Malignant lymphoma encompasses a wide variety of distinct disease entities. It is generally more common in developed countries and less common in developing countries. The East Asia region has one of the lowest incidence rates of malignant lymphoma. The incidence of malignant lymphoma around the world has been increasing at a rate of 3-4% over the last 4 decades, while some stabilization has been observed in developed countries in recent years. The reasons behind this lymphoma epidemic are poorly understood, although improving diagnostic accuracy, the recent AIDS epidemic, an aging world population and the increasing adoption of cancer-causing behaviors are suggested as contributing factors. Etiologies of malignant lymphoma include infectious agents, immunodeficiency, autoimmune disease, exposure to certain organic chemicals, and pharmaceuticals. The distribution of many subtypes exhibit marked geographic variations. Compared to the West, T/natural killer (NK) cell lymphomas (T/NK-cell lymphoma) and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are relatively more common, whereas other B-cell lymphomas, particularly follicular lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, are less common in Asia. Some subtypes of T/NK-cell lymphomas defined by Epstein-Barr virus association are predominantly Asian diseases, if not exclusively so. Both ethnic and environmental factors play roles in such diversity. In this review, we discuss the geographic distribution and etiology of malignant lymphoma, as well as the trend.
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Affiliation(s)
- Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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