Department of Oncology and Radiotherapy, Edgardo Rebagliati Martins Hospital, Lima, Peru.
Am J Hematol. 2011 Aug;86(8):663-7. doi: 10.1002/ajh.22078.
EBV-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is an entity recently included in the WHO classification of lymphoid tumors. We have reviewed our experience and clinical outcomes of this distinct subtype of DLBCL. Between 2002 and 2009, cases of DLBCL were identified from medical records of the Hospital Nacional Edgardo Rebagliati Martins in Lima, Peru, and underwent pathological evaluation including immunohistochemistry for CD20, CD10, bcl-6, MUM1/IRF4, and EBV-encoded RNA in situ hybridization. Clinical data were gathered, tabulated, and reported descriptively. Survival analyses were performed using Kaplan-Meier estimates. Out of 199 cases of DLBCL, 28 cases of EBV-positive DLBCL of the elderly were identified. The median age was 75 years with male predominance (1.5:1). B-symptoms were present in 43%, advanced stage in 50% and International Prognostic Index (IPI) score > 2 in 57% of patients; 68% of patients had a nongerminal center (NGC) phenotype. The complete response rates to R-CHOP and CHOP were 63% and 33%, respectively. The median overall survival (OS) for the group was 5 months. In the univariate analysis, age ≥70 years, lymphocyte count <1.0 × 10(9) /L, and advanced clinical stage were associated with worse OS in patients treated with chemotherapy with and without rituximab. EBV-positive DLBCL of the elderly is a clinically aggressive entity with a short OS and typically presents with advanced stage, high IPI score, and a NGC phenotype. Further studies are needed to investigate if rituximab-containing regimens are associated with better response and OS rates in EBV-positive DLBCL of the elderly.
老年 EBV 阳性弥漫性大 B 细胞淋巴瘤（DLBCL）是最近被纳入世界卫生组织淋巴肿瘤分类的一种实体瘤。我们回顾了我们在这种独特的 DLBCL 亚型中的经验和临床结果。在 2002 年至 2009 年间，我们从秘鲁利马的埃斯帕达·里瓦格亚蒂·马丁内斯国家医院的病历中确定了 DLBCL 病例，并进行了病理评估，包括 CD20、CD10、bcl-6、MUM1/IRF4 和 EBV 编码 RNA 的免疫组织化学原位杂交。收集、制表和报告临床数据。使用 Kaplan-Meier 估计进行生存分析。在 199 例 DLBCL 中，确定了 28 例老年 EBV 阳性 DLBCL。中位年龄为 75 岁，男性居多（1.5:1）。43%的患者有 B 症状，50%的患者处于晚期，57%的患者国际预后指数（IPI）评分>2；68%的患者具有非生发中心（NGC）表型。R-CHOP 和 CHOP 的完全缓解率分别为 63%和 33%。该组的中位总生存期（OS）为 5 个月。在单变量分析中，年龄≥70 岁、淋巴细胞计数<1.0×10(9)/L 和晚期临床分期与接受含或不含利妥昔单抗的化疗的患者的 OS 较差相关。老年 EBV 阳性 DLBCL 是一种具有侵袭性的实体瘤，OS 较短，通常表现为晚期、高 IPI 评分和 NGC 表型。需要进一步研究来探讨利妥昔单抗联合方案是否与老年 EBV 阳性 DLBCL 的更好反应和 OS 率相关。
