Article: Outcomes among US patients with diffuse large B cell lymphoma are independent of tumor Epstein Barr virus positivity or immunosuppression
Authors: Sean I. Tracy, Thomas M. Habermann, Andrew L. Feldman, Matthew J. Maurer, Ahmet Dogan, Usha S. Perepu, Sergei Syrbu, Stephen M. Ansell, Carrie A. Thompson, George J. Weiner, Grzegorz S. Nowakowski, Cristine Allmer, Susan L. Slager, Thomas E. Witzig, James R. Cerhan, Brian K. Link
Journal: Haematologica. 2017 Nov 23. pii: haematol.2017.176511. doi: 10.3324/haematol.2017.176511. [Epub ahead of print]
The prevalence, presenting clinical and pathologic characteristics, and outcomes for patients with diffuse large B-cell lymphoma that is Epstein-Barr Virus positive remains 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 with Human Immunodeficiency Virus or prior organ transplant were excluded. Epstein-Barr-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%) of the biopsies were positive for Epstein-Barr Virus. 39 (10.8%) 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% vs 8.1%; P < 0.01), and non-germinal-center subtype (62.5% vs 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% CI 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 impact subsequent prognosis.
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