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

Sean I. Tracy, Thomas Matthew Habermann, Andrew L Feldman, Matthew J. Maurer, Ahmet Dogan, Usha S. Perepu, Sergei Syrbu, Stephen Maxted Ansell, Carrie A Thompson, George J. Weiner, Grzegorz S Nowakowski, Cristine Allmer, Susan L Slager, Thomas Elmer Witzig, James R Cerhan, Brian K. Link

Research output: Contribution to journalArticle

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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. Thirtynine (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 eventfree 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.

Original languageEnglish (US)
Pages (from-to)297-303
Number of pages7
JournalHaematologica
Volume103
Issue number2
DOIs
StatePublished - Jan 31 2018

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Oncogenic Viruses
Lymphoma, Large B-Cell, Diffuse
Human Herpesvirus 4
Immunosuppression
Confidence Intervals
Odds Ratio
Survival
Molecular Epidemiology
Population
HIV
RNA
Pathology
Transplants
Biopsy

ASJC Scopus subject areas

  • Hematology

Cite this

Outcomes among North American patients with diffuse large b-cell lymphoma are independent of tumor Epstein-Barr virus positivity or immunosuppression. / Tracy, Sean I.; Habermann, Thomas Matthew; Feldman, Andrew L; Maurer, Matthew J.; Dogan, Ahmet; Perepu, Usha S.; Syrbu, Sergei; Ansell, Stephen Maxted; Thompson, Carrie A; Weiner, George J.; Nowakowski, Grzegorz S; Allmer, Cristine; Slager, Susan L; Witzig, Thomas Elmer; Cerhan, James R; Link, Brian K.

In: Haematologica, Vol. 103, No. 2, 31.01.2018, p. 297-303.

Research output: Contribution to journalArticle

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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. Thirtynine (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 eventfree 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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AU - Dogan, Ahmet

AU - Perepu, Usha S.

AU - Syrbu, Sergei

AU - Ansell, Stephen Maxted

AU - Thompson, Carrie A

AU - Weiner, George J.

AU - Nowakowski, Grzegorz S

AU - Allmer, Cristine

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AU - Witzig, Thomas Elmer

AU - Cerhan, James R

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