Epstein-Barr Virus Status as Prognostic Factor in Nodal Diffuse Large B-Cell Lymphoma in Elderly Patients

BACKGROUND: Epstein-Barr vitus (EBV)-positive status is related to a poor survival in patients with Hodgkin lymphoma, T-cell non-Hodgkin lymphoma (NHL) and, in a recent publication from Asia, in patients with diffuse large B-cell lymphoma (DLBCL). AIM: In order to define the impact of EBV infection on survival in patients with nodal DLBCL, we investigated the EBV status in elderly Peruvian patients with a diagnosis of DLBCL. PATIENTS AND METHODS: Between January 2002 and December 2004, thirty-eight patients older than 70 years who were diagnosed with nodal DLBCL were included in the analysis. Clinical data were reviewed retrospectively from the patients’ records. Nodal tissue from all cases was analyzed for the presence of EBV encoded RNA (EBER) using the in situ hybridization (ISH) method. Survival analysis was performed using the Kaplan-Meier method. RESULTS: Eight cases (21%) were identified as EBV-positive; the remaining 30 cases (79%) were EBV-negative. Within clinical characteristics, EBV-positivity was associated with poorer performance status, more advanced stage and higher IPI scores. From the 8 EBV-positive cases, two cases (25%) had a germinal center (GC)-like phenotype, whereas the other six (75%) had a non-germinal center phenotype. Overall survival for EBV-positive DLBCL patients was 0.5 months and for EBV-negative patients was 14 months (p = 0.002). In the multivariate analysis, EBV status emerged as an independent variable for survival when evaluated against the IPI score (p = 0.001). There were no differences in survival between DLBCL phenotype (GC versus non-GC). CONCLUSION: EBV status in elderly patients with nodal DLBCL is a powerful survival prognostic factor and its role in the survival of other lymphoproliferative disorders and age groups should be investigated. New therapeutic strategies should be defined in patients with EBV-positive DLBCL.