Pretreatment Epstein-Barr virus DNA in whole blood is a prognostic marker in peripheral T-cell lymphoma

Yu Ri Kim, Soo-Jeong Kim, June-Won Cheong, Haerim Chung, Ji Eun Jang, Yundeok Kim, Woo-Ick Yang, Yoo Hong Min, Jin Seok Kim, Yu Ri Kim, Soo-Jeong Kim, June-Won Cheong, Haerim Chung, Ji Eun Jang, Yundeok Kim, Woo-Ick Yang, Yoo Hong Min, Jin Seok Kim

Abstract

Because there are few studies regarding the clinical impact of circulating EBV-DNA in peripheral T-cell lymphomas (PTCLs), we tried to evaluate the role of EBV-DNA in whole blood as a prognostic factor for PTCL. We retrospectively reviewed 110 PTCL patients with median age of 63 (20-94) years. Forty-seven patients (42.7%) showed positive results for EBV-DNA, and these patients also had stage III/IV disease, elevated lactic dehydrogenase, and low albumin level (P = 0.007, P = 0.004, P = 0.002, respectively). The 5-year overall survival (OS) and progression free survival (PFS) were 21.0% and 18.0%. Univariable analysis showed that positive EBV-DNA was related with inferior OS and PFS (P = 0.015 and P < 0.001, respectively). Multivariable analysis showed that poor performance status, extranodal involvement more than one site and positive EBV-DNA results were related with OS and PFS (P < 0.001, P < 0.001, P = 0.007 and P = 0.001, P = 0.002, P < 0.001, respectively). Using these three variables, we made a new prognostic model which classified patients on risk as follows: low, no adverse factors; intermediate, 1 factor; or high, 2-3 factors. The new prognostic model could stratify the three groups for OS and PFS better than either international prognostic index or prognostic index of PTCL-u, and showed statistical significance in PTCL, not otherwise specified. This study suggests that whole blood EBV-DNA is related with aggressive clinical characteristics and inferior survival. The new prognostic model, which incorporates EBV-DNA, could better stratify PTCL patients.

Keywords: Epstein-Barr virus; peripheral T-cell lymphoma; prognostic score; whole blood.

Conflict of interest statement

CONFLICTS OF INTEREST The authors have no conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
Overall survival (A) and progression free survival (B) according to EBV-DNA positivity.
Figure 2. Overall survival (OS) and progression…
Figure 2. Overall survival (OS) and progression free survival (PFS) according to international prognostic index (IPI) and to prognostic index for PTCLu (PIT)
(A) OS of IPI, (B) PFS of IPI (C) OS of PIT (D) PFS of PIT. The tables within the figure show the P-value between each factor by log-rank test. Abbreviations: L; Low, LI; low- intermediate, HI; high-intermediate, H; high.
Figure 3. Overall survival (OS) and progression…
Figure 3. Overall survival (OS) and progression free survival (PFS) according to the new prognostic model. The tables within the figure show the comparison between each factor by log-rank test
(A) OS, (B) PFS of the new prognostic model, (C) OS, (D) PFS of new prognostic model in peripheral T-cell lymphoma, NOS (PTCL, NOS). The tables within figure show the P-value between each factor by log-rank test.

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