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Impact of Tumour Epstein–Barr Virus Status on Clinical Outcome in Patients with Classical Hodgkin Lymphoma (cHL): A Review of the Literature and Analysis of a Clinical Trial Cohort of Children with cHL. Cancers (Basel) 2022; 14:cancers14174297. [PMID: 36077832 PMCID: PMC9454639 DOI: 10.3390/cancers14174297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The Epstein–Barr virus (EBV) contributes to different forms of human cancer, including a subset of classical Hodgkin lymphoma (cHL), a B-cell lymphoma with unusual histological features. Although the pathogenesis of EBV-associated cHL remains to be elucidated, biological investigations point to an important aetiological role for the virus in the development of this tumour. This is even more relevant now considering the potential opportunities that exist to treat EBV-associated disorders, for example, with immunotherapeutics or small molecule inhibitors targeting viral proteins. For this reason, we believe it is now timely to review the association between EBV and cHL and in particular to re-evaluate the impact of EBV status on clinical outcomes in cHL patients. Herein, we also report the impact of EBV on clinical outcomes in a cohort of children and adolescents with cHL. Abstract In this study, we have re-evaluated how EBV status influences clinical outcome. To accomplish this, we performed a literature review of all studies that have reported the effect of EBV status on patient outcome and also explored the effect of EBV positivity on outcome in a clinical trial of children with cHL from the UK. Our literature review revealed that almost all studies of older adults/elderly patients have reported an adverse effect of an EBV-positive status on outcome. In younger adults with cHL, EBV-positive status was either associated with a moderate beneficial effect or no effect, and the results in children and adolescents were conflicting. Our own analysis of a series of 166 children with cHL revealed no difference in overall survival between EBV-positive and EBV-negative groups (p = 0.942, log rank test). However, EBV-positive subjects had significantly longer event-free survival (p = 0.0026). Positive latent membrane protein 1 (LMP1) status was associated with a significantly lower risk of treatment failure in a Cox regression model (HR = 0.21, p = 0.005). In models that controlled for age, gender, and stage, EBV status had a similar effect size and statistical significance. This study highlights the age-related impact of EBV status on outcome in cHL patients and suggests different pathogenic effects of EBV at different stages of life.
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Singh D, Vaccarella S, Gini A, De Paula Silva N, Steliarova-Foucher E, Bray F. Global patterns of Hodgkin lymphoma incidence and mortality in 2020 and a prediction of the future burden in 2040. Int J Cancer 2022; 150:1941-1947. [PMID: 35080783 DOI: 10.1002/ijc.33948] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/06/2022]
Abstract
Our study examines global patterns of Hodgkin lymphoma (HL) in 2020 and predicts the future incidence and mortality burden in 2040 using IARC's GLOBOCAN estimates of the number of new cases and deaths of HL in 185 countries. A total of 83 000 new cases of HL and 23 000 deaths from HL were estimated in 2020. In general, incidence and mortality rates were consistently higher in males (50% more cases and deaths than females) across world regions and countries. Incidence rates varied markedly by world region, at least 10-fold in both sexes, with the highest incidence rates observed in Southern Europe. Mortality exhibited an inverse pattern compared to incidence, with rates elevated in Western Asia and Northern Africa. The number of HL incident cases is predicted to rise to around 107 000 cases (a 30% increase) by 2040 due to demographic changes, assuming global rates in 2020 remains unchanged. The findings provide a baseline and impetus for developing strategies that aim to reduce the burden of HL in future decades.
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Affiliation(s)
- Deependra Singh
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Andrea Gini
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Neimar De Paula Silva
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Mahajan A, Bakhshi S, Seth R, Verma N, Mandal P, Singh M, Jain S, Radhakrishnan V, Kanvinde S, Arora RS, Dinand V, Kalra M, Taluja A, Mallick S, Kumar R, Chandra J. Hodgkin Lymphoma in Children Under 5 Years: Do They Behave Differently? J Pediatr Hematol Oncol 2022; 44:186-190. [PMID: 35293880 DOI: 10.1097/mph.0000000000002423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/15/2021] [Indexed: 01/09/2023]
Abstract
The median age of presentation for Hodgkin lymphoma (HL) is lower in developing countries with a higher proportion under 5 years of age possibly attributable to the high prevalence of Epstein-Barr virus-driven disease. It is unclear whether the clinical presentation and outcomes of this cohort are different with concern regarding late effects being most pronounced in this age group. We report the outcome of children under 5 years of age enrolled in the InPOG-HL-15-01, the first multicentric collaborative study for newly diagnosed children and adolescents with HL from India. Thirty-five (9%) of the study population was younger than 5 years with a striking male preponderance of 34:1. They were less likely to have bulky disease, mediastinal or splenic involvement. The outcomes appear to be at least as favorable as in the older patient group. Efforts need to be made to evolve treatment strategies that spare this very young cohort from potential late effects.
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Affiliation(s)
- Amita Mahajan
- Department of Pediatric Oncology, Indraprastha Apollo Hospital
| | | | - Rachna Seth
- Department of Pediatrics, All India Institute of Medical Sciences
| | - Nishant Verma
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh
| | - Piali Mandal
- Department of Pediatrics, Kalawati Saran Children's Hospital
| | - Manisha Singh
- Department of Medical and Pediatric Oncology, Mahavir Cancer Sansthan, Patna, Bihar
| | - Sandeep Jain
- Department of Pediatric Oncology, Rajiv Gandhi Cancer Institute
| | | | - Shailesh Kanvinde
- Department of Pediatric Hematology Oncology, Deenanath Mangeshkar Hospital, Pune
| | - Raman S Arora
- Department of Pediatric Oncology, Max Super Specialty Hospital
| | - Veronique Dinand
- Palliative and Supportive Unit, BJ Wadia Hospital, Mumbai, Maharashtra, India
| | - Manas Kalra
- Department of Pediatric Oncology, Sir Ganga Ram Hospital
| | | | | | | | - Jagdish Chandra
- Department of Pediatrics, Kalawati Saran Children's Hospital
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Moore KJ, Hubbard AK, Williams LA, Spector LG. Childhood cancer incidence among specific Asian and Pacific Islander populations in the United States. Int J Cancer 2020; 147:3339-3348. [PMID: 32535909 PMCID: PMC7736474 DOI: 10.1002/ijc.33153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/21/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022]
Abstract
Despite the vast genetic and environmental diversity in Asia, individuals of Asian and Pacific Islander (API) descent are often combined into a single group for epidemiologic analyses within the U.S. We used the Surveillance, Epidemiology and End Results (SEER) Detailed Asian/Pacific Islander Database to calculate incidence rates for discrete groups among children aged 0 to 19 years. Due to sample size constraints we pooled incidence among regional groups based on countries of origin: East Asians (Chinese, Japanese, Korean), Southeast (SE) Asians (Vietnamese, Laotian, Cambodian), Asian Indian/Pakistani, Oceanians (Guamanian, Samoan, Tongan) and Filipinos. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated comparing each API regional group to Non-Hispanic Whites (NHW) and East Asians. Finally, we calculated the correlation between incidence of cancer in specific API ethnicities in SEER and in originating countries in the Cancer Incidence in Five Continents. Incidence rates among API regional groups varied. Acute lymphoblastic leukemia (ALL) was lower in children of SE Asian descent (IRR 0.65, 95% CI 0.44, 0.96) compared to NHW. Acute myeloid leukemia (AML) was more common among children from Oceania compared to NHW (IRR 3.88, 95% CI 1.83, 8.22). East Asians had higher incidence rates than SE Asians but lower rates compared to children from Oceania. Correlation of some incidence rates between US-based API ethnicities and originating countries were similar. The variation observed in childhood cancer incidence patterns among API groups may indicate differences in underlying genetics and/or patterns of exposure.
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Affiliation(s)
- Kristin J. Moore
- Program in Health Disparities Research, University of Minnesota Medical School, University of Minnesota
| | - Aubrey K. Hubbard
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota
| | - Lindsay A. Williams
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota
- Masonic Cancer Center, University of Minnesota
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota
- Masonic Cancer Center, University of Minnesota
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An etiological role for the Epstein-Barr virus in the pathogenesis of classical Hodgkin lymphoma. Blood 2019; 134:591-596. [DOI: 10.1182/blood.2019000568] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/06/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Although a pathogenic role for the Epstein-Barr virus (EBV) is largely undisputed for tumors that are consistently EBV genome positive (eg, nasopharyngeal carcinoma, endemic Burkitt lymphoma), this is not the case for classical Hodgkin lymphoma (cHL), a tumor with only a variable EBV association. In light of recent developments in immunotherapeutics and small molecules targeting EBV, we believe it is now timely to reevaluate the role of EBV in cHL pathogenesis.
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Vrzalikova K, Ibrahim M, Nagy E, Vockerodt M, Perry T, Wei W, Woodman C, Murray P. Co-Expression of the Epstein-Barr Virus-Encoded Latent Membrane Proteins and the Pathogenesis of Classic Hodgkin Lymphoma. Cancers (Basel) 2018; 10:cancers10090285. [PMID: 30149502 PMCID: PMC6162670 DOI: 10.3390/cancers10090285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
The Epstein-Barr virus (EBV) is present in the tumour cells of a subset of patients with classic Hodgkin lymphoma (cHL), yet the contribution of the virus to the pathogenesis of these tumours remains only poorly understood. The EBV genome in virus-associated cHL expresses a limited subset of genes, restricted to the non-coding Epstein-Barr virus-encoded RNAs (EBERs) and viral miRNA, as well as only three virus proteins; the Epstein-Barr virus nuclear antigen-1 (EBNA1), and the two latent membrane proteins, known as LMP1 and LMP2, the latter of which has two isoforms, LMP2A and LMP2B. LMP1 and LMP2A are of particular interest because they are co-expressed in tumour cells and can activate cellular signalling pathways, driving aberrant cellular transcription in infected B cells to promote lymphomagenesis. This article seeks to bring together the results of recent studies of the latent membrane proteins in different B cell systems, including experiments in animal models as well as a re-analysis of our own transcriptional data. In doing so, we summarise the potentially co-operative and antagonistic effects of the LMPs that are relevant to B cell lymphomagenesis.
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Affiliation(s)
- Katerina Vrzalikova
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
- Correspondence: ; Tel.: +44-121-414-4021
| | - Maha Ibrahim
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
| | - Eszter Nagy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
| | - Martina Vockerodt
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
- Institute of Anatomy and Cell Biology, Georg-August University of Göttingen, 37099 Göttingen, Germany
| | - Tracey Perry
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
| | - Wenbin Wei
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
- Sheffield Institute of Translational Neuroscience, University of Sheffield, Sheffield S102HQ, UK
| | - Ciaran Woodman
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
| | - Paul Murray
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (M.I.); (E.N.); (M.V.); (T.P.); (W.W.); (P.M.)
- Department of Clinical and Molecular Pathology, Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, 77515 Olomouc, Czech Republic
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Vrzalikova K, Sunmonu T, Reynolds G, Murray P. Contribution of Epstein⁻Barr Virus Latent Proteins to the Pathogenesis of Classical Hodgkin Lymphoma. Pathogens 2018; 7:pathogens7030059. [PMID: 29954084 PMCID: PMC6161176 DOI: 10.3390/pathogens7030059] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023] Open
Abstract
Pathogenic viruses have evolved to manipulate the host cell utilising a variety of strategies including expression of viral proteins to hijack or mimic the activity of cellular functions. DNA tumour viruses often establish latent infection in which no new virions are produced, characterized by the expression of a restricted repertoire of so-called latent viral genes. These latent genes serve to remodel cellular functions to ensure survival of the virus within host cells, often for the lifetime of the infected individual. However, under certain circumstances, virus infection may contribute to transformation of the host cell; this event is not a usual outcome of infection. Here, we review how the Epstein–Barr virus (EBV), the prototypic oncogenic human virus, modulates host cell functions, with a focus on the role of the EBV latent genes in classical Hodgkin lymphoma.
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Affiliation(s)
- Katerina Vrzalikova
- Institute for Cancer and Genomic Medicine, University of Birmingham, Birmingham B15 2TT, UK.
| | - Taofik Sunmonu
- Institute for Cancer and Genomic Medicine, University of Birmingham, Birmingham B15 2TT, UK.
| | - Gary Reynolds
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK.
| | - Paul Murray
- Institute for Cancer and Genomic Medicine, University of Birmingham, Birmingham B15 2TT, UK.
- Department of Clinical and Molecular Pathology, Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, 775 15 Olomouc, Czech Republic.
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9
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Sayeed S, Barnes I, Ali R. Childhood cancer incidence by ethnic group in England, 2001-2007: a descriptive epidemiological study. BMC Cancer 2017; 17:570. [PMID: 28841853 PMCID: PMC5574126 DOI: 10.1186/s12885-017-3551-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 08/14/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND After the first year of life, cancers are the commonest cause of death in children. Incidence rates vary between ethnic groups, and recent advances in data linkage allow for a more accurate estimation of these variations. Identifying such differences may help identify potential risk or protective factors for certain childhood cancers. This study thus aims to ascertain whether such differences do indeed exist using nationwide data across seven years, as have previously been described in adult cancers. METHODS We obtained data for all cancer registrations for children (aged 0-14) in England from January 2001 to December 2007. Ethnicity (self-assigned) was established through record linkage to the Hospital Episodes Statistics database or cancer registry data. Cancers were classified morphologically according to the International Classification of Childhood Cancer into four groups - leukaemias; lymphomas; central nervous system; and other solid tumours. Age standardised incidence rates were estimated for each ethnic group, as well as incidence rate ratios comparing each individual ethnic group (Indian, Pakistani, Bangladeshi, Black African, Black Carribean, Chinese) to Whites, adjusting for sex, age and deprivation. RESULTS The majority of children in the study are UK born. Black children (RR = 1.18, 99% CI: 1.01-1.39), and amongst South Asians, Pakistani children (RR = 1.19, 99% CI: 1.02-1.39) appear to have an increased risk of all cancers. There is an increased risk of leukaemia in South Asians (RR = 1.31, 99% CI: 1.08-1.58), and of lymphoma in Black (RR = 1.72, 99% CI: 1.13-2.63) and South Asian children (RR = 1.51, 99% CI: 1.10-2.06). South Asians appear to have a decreased risk of CNS cancers (RR = 0.71, 99% CI: 0.54-0.95). CONCLUSIONS In the tradition of past migrant studies, such descriptive studies within ethnic minority groups permit a better understanding of disease incidence within the population, but also allow for the generation of hypotheses to begin to understand why such differences might exist. Though a major cause of mortality in this age group, childhood cancer remains a relatively rare disease; however, the methods used here have permitted the first nationwide estimation of childhood cancer by individual ethnic group.
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Affiliation(s)
- Shameq Sayeed
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK
| | - Isobel Barnes
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK
| | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK. .,Public Health Research Center, New York University Abu Dhabi , Abu Dhabi, United Arab Emirates.
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Incidence and time trends of childhood lymphomas: findings from 14 Southern and Eastern European cancer registries and the Surveillance, Epidemiology and End Results, USA. Cancer Causes Control 2016; 27:1381-1394. [PMID: 27757777 DOI: 10.1007/s10552-016-0817-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 10/06/2016] [Indexed: 02/01/2023]
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11
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Jansen MAE, van den Heuvel D, Bouthoorn SH, Jaddoe VWV, Hooijkaas H, Raat H, Fraaij PLA, van Zelm MC, Moll HA. Determinants of Ethnic Differences in Cytomegalovirus, Epstein-Barr Virus, and Herpes Simplex Virus Type 1 Seroprevalence in Childhood. J Pediatr 2016; 170:126-34.e1-6. [PMID: 26707579 DOI: 10.1016/j.jpeds.2015.11.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/23/2015] [Accepted: 11/05/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify whether there are ethnic differences in cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus type 1 (HSV-1) seroprevalence rates in children at 6 years of age, and when present, to evaluate how these differences can be explained by sociodemographic and environmental factors. STUDY DESIGN This study was embedded within a multi-ethnic population-based prospective cohort study. Serum IgG levels against CMV, EBV, and HSV-1 were measured by enzyme-linked immunosorbent assay in 4464 children (median age 6.0 years). Information on demographics and characteristics were assessed by questionnaires. Herpesvirus seroprevalences between Surinamese-Creole, Surinamese-Hindustani, Turkish, Moroccan, Cape Verdean Antillean, and Native Dutch children were compared. RESULTS Non-Western ethnicity was an independent risk factor for CMV (aOR, 2.16; 95% CI 1.81-2.57), EBV (1.76; 1.48-2.09), and HSV-1 seropositivity (1.52; 1.39-1.66). Among the ethnic groups, CMV seroprevalences ranged between 29% and 65%, EBV between 43% and 69%, and HSV-1 between 13% and 39%. Low family net household income, low maternal educational level, crowding, and lifestyle factors explained up to 48% of the ethnic differences in HSV-1 seroprevalences, and up to 39% of the ethnic differences in EBV seroprevalences. These factors did not explain ethnic differences in CMV seroprevalences. CONCLUSIONS Socioeconomic position and factors related to lifestyle explain only a part of the large ethnic differences in EBV and HSV-1 seroprevalences, whereas they do not explain ethnic differences in CMV seroprevalences in childhood.
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Affiliation(s)
- Michelle A E Jansen
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diana van den Heuvel
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Selma H Bouthoorn
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Herbert Hooijkaas
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Pieter L A Fraaij
- Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Viroscience, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Menno C van Zelm
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Henriette A Moll
- Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands.
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12
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Ali AS, Al-Shraim M, Al-Hakami AM, Jones IM. Epstein- Barr Virus: Clinical and Epidemiological Revisits and Genetic Basis of Oncogenesis. Open Virol J 2015; 9:7-28. [PMID: 26862355 PMCID: PMC4740969 DOI: 10.2174/1874357901509010007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 06/08/2015] [Accepted: 09/18/2015] [Indexed: 12/21/2022] Open
Abstract
Epstein-Barr virus (EBV) is classified as a member in the order herpesvirales, family herpesviridae, subfamily gammaherpesvirinae and the genus lymphocytovirus. The virus is an exclusively human pathogen and thus also termed as human herpesvirus 4 (HHV4). It was the first oncogenic virus recognized and has been incriminated in the causation of tumors of both lymphatic and epithelial nature. It was reported in some previous studies that 95% of the population worldwide are serologically positive to the virus. Clinically, EBV primary infection is almost silent, persisting as a life-long asymptomatic latent infection in B cells although it may be responsible for a transient clinical syndrome called infectious mononucleosis. Following reactivation of the virus from latency due to immunocompromised status, EBV was found to be associated with several tumors. EBV linked to oncogenesis as detected in lymphoid tumors such as Burkitt's lymphoma (BL), Hodgkin's disease (HD), post-transplant lymphoproliferative disorders (PTLD) and T-cell lymphomas (e.g. Peripheral T-cell lymphomas; PTCL and Anaplastic large cell lymphomas; ALCL). It is also linked to epithelial tumors such as nasopharyngeal carcinoma (NPC), gastric carcinomas and oral hairy leukoplakia (OHL). In vitro, EBV many studies have demonstrated its ability to transform B cells into lymphoblastoid cell lines (LCLs). Despite these malignancies showing different clinical and epidemiological patterns when studied, genetic studies have suggested that these EBV- associated transformations were characterized generally by low level of virus gene expression with only the latent virus proteins (LVPs) upregulated in both tumors and LCLs. In this review, we summarize some clinical and epidemiological features of EBV- associated tumors. We also discuss how EBV latent genes may lead to oncogenesis in the different clinical malignancies
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Affiliation(s)
- Abdelwahid Saeed Ali
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ahmed Musa Al-Hakami
- Department of Microbiology and Clinical Parasitology, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
| | - Ian M Jones
- Department of Biomedical Sciences, School of Biological Sciences, Faculty of Life Sciences, University of Reading, G37 AMS Wing, UK
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Lau CS, Chia F, Harrison A, Hsieh TY, Jain R, Jung SM, Kishimoto M, Kumar A, Leong KP, Li Z, Lichauco JJ, Louthrenoo W, Luo SF, Nash P, Ng CT, Park SH, Suryana BPP, Suwannalai P, Wijaya LK, Yamamoto K, Yang Y, Yeap SS. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis 2015; 18:685-713. [DOI: 10.1111/1756-185x.12754] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Chak Sing Lau
- Division of Rheumatology and Clinical Immunology; Queen Mary Hospital; University of Hong Kong; Hong Kong
| | - Faith Chia
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Andrew Harrison
- Department of Medicine; University of Otago Wellington; Wellington South New Zealand
| | - Tsu-Yi Hsieh
- Section of Allergy, Immunology and Rheumatology, and Section of Clinical Skills Training; Taichung Veterans General Hospital; Taichung Taiwan
| | | | - Seung Min Jung
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | | | - Ashok Kumar
- Department of Rheumatology; Fortis Flt. Lt Rajan Dhall Hospital; New Delhi India
| | - Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore City Singapore
| | - Zhanguo Li
- Department of Rheumatology; Peking University People's Hospital; Beijing China
| | | | - Worawit Louthrenoo
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Shue-Fen Luo
- Department of Rheumatology, Allergy and Immunology; Chang Gung Memorial Hospital and Chang Gung University; Tao-Yuan Taiwan
| | - Peter Nash
- Department of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Chin Teck Ng
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore City Singapore
| | - Sung-Hwan Park
- Division of Rheumatology; Department of Internal Medicine; The Catholic University of Korea; St. Mary's Hospital; Seoul South Korea
| | - Bagus Putu Putra Suryana
- Rheumatology Division; Department of Internal Medicine; Brawijaya University; Saiful Anwar General Hospital; Malang Indonesia
| | - Parawee Suwannalai
- Allergy, Immunology and Rheumatology Division; Internal Medicine Department; Faculty of Medicine; Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Linda Kurniaty Wijaya
- Division of Rheumatology; Department of Internal Medicine; University of Indonesia; Jakarta Indonesia
| | - Kazuhiko Yamamoto
- Department of Allergy and Rheumatology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yue Yang
- Department of Rheumatology; Peking University People's Hospital; Beijing China
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14
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Vockerodt M, Yap LF, Shannon-Lowe C, Curley H, Wei W, Vrzalikova K, Murray PG. The Epstein-Barr virus and the pathogenesis of lymphoma. J Pathol 2015; 235:312-22. [PMID: 25294567 DOI: 10.1002/path.4459] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/01/2014] [Accepted: 10/05/2014] [Indexed: 02/06/2023]
Abstract
Since the discovery in 1964 of the Epstein-Barr virus (EBV) in African Burkitt lymphoma, this virus has been associated with a remarkably diverse range of cancer types. Because EBV persists in the B cells of the asymptomatic host, it can easily be envisaged how it contributes to the development of B-cell lymphomas. However, EBV is also found in other cancers, including T-cell/natural killer cell lymphomas and several epithelial malignancies. Explaining the aetiological role of EBV is challenging, partly because the virus probably contributes differently to each tumour and partly because the available disease models cannot adequately recapitulate the subtle variations in the virus-host balance that exist between the different EBV-associated cancers. A further challenge is to identify the co-factors involved; because most persistently infected individuals will never develop an EBV-associated cancer, the virus cannot be working alone. This article will review what is known about the contribution of EBV to lymphoma development.
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Affiliation(s)
- Martina Vockerodt
- Centre for Human Virology and the School of Cancer Sciences, University of Birmingham, Birmingham, UK
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15
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Murray P, Bell A. Contribution of the Epstein-Barr Virus to the Pathogenesis of Hodgkin Lymphoma. Curr Top Microbiol Immunol 2015; 390:287-313. [PMID: 26424651 DOI: 10.1007/978-3-319-22822-8_12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The morphology of the pathognomonic Hodgkin and Reed-Sternberg cells (HRS) of Hodgkin lymphoma was described over a century ago, yet it was only relatively recently that the B-cell origin of these cells was identified. In a proportion of cases, HRS cells harbour monoclonal forms of the B lymphotropic Epstein-Barr virus (EBV). This review summarises current knowledge of the pathogenesis of Hodgkin lymphoma with a particular emphasis on the contribution of EBV.
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Affiliation(s)
- Paul Murray
- School of Cancer Sciences and Centre for Human Virology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, B15 2TT, UK.
| | - Andrew Bell
- School of Cancer Sciences and Centre for Human Virology, College of Medical and Dental Sciences, University of Birmingham, Birmingham, Edgbaston, B15 2TT, UK.
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16
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Nelson P, Rylance P, Roden D, Trela M, Tugnet N. Viruses as potential pathogenic agents in systemic lupus erythematosus. Lupus 2014; 23:596-605. [PMID: 24763543 DOI: 10.1177/0961203314531637] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Genetic and environmental factors appear to contribute to the pathogenesis of systemic lupus erythematosus (SLE). Viral infections have been reported to be associated with the disease. A number of exogenous viruses have been linked to the pathogenesis of SLE, of which Epstein-Barr virus (EBV) has the most evidence of an aetiological candidate. In addition, human endogenous retroviruses (HERV), HRES-1, ERV-3, HERV-E 4-1, HERV-K10 and HERV-K18 have also been implicated in SLE. HERVs are incorporated into human DNA, and thus can be inherited. HERVs may trigger an autoimmune reaction through molecular mimicry, since homology of amino acid sequences between HERV proteins and SLE autoantigens has been demonstrated. These viruses can also be influenced by oestrogen, DNA hypomethylation, and ultraviolet light (UVB) exposure which have been shown to enhance HERV activation or expression. Viral infection, or other environmental factors, could induce defective apoptosis, resulting in loss of immune tolerance. Further studies in SLE and other autoimmune diseases are needed to elucidate the contribution of both exogenous and endogenous viruses in the development of autoimmunity. If key peptide sequences could be identified as molecular mimics between viruses and autoantigens, then this might offer the possibility of the development of blocking peptides or antibodies as therapeutic agents in SLE and other autoimmune conditions.
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Affiliation(s)
- P Nelson
- 1Molecular Immunology Research Group, Research Institute in Healthcare Science, University of Wolverhampton, UK
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17
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Mohamed G, Vrzalikova K, Cader FZ, Vockerodt M, Nagy E, Flodr P, Yap LF, Diepstra A, Kluin PM, Rosati S, Murray P. Epstein-Barr virus, the germinal centre and the development of Hodgkin's lymphoma. J Gen Virol 2014; 95:1861-1869. [PMID: 24893782 DOI: 10.1099/vir.0.066712-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The relationship between Epstein-Barr virus (EBV) and the germinal centre (GC) of the asymptomatic host remains an enigma. The occasional appearance of EBV-positive germinal centres in some patients, particularly those with a history of immunosuppression, suggests that EBV numbers in the GC are subject to immune control. The relationship, if any, between lymphoid hyperplasia with EBV-positive germinal centres and subsequent or concurrent lymphomagenesis remains to be clarified. As far as the development of EBV-associated Hodgkin's lymphoma is concerned, the suppression of virus replication, mediated by LMP1 on the one hand, and the loss of B-cell receptor signalling on the other, appears to be an important pathogenic mechanism. A further important emerging concept is that alterations in the microenvironment of the EBV-infected B-cell may be important for lymphomagenesis.
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Affiliation(s)
- Ghada Mohamed
- Centre for Human Virology and the School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Katerina Vrzalikova
- Centre for Human Virology and the School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Fathima Zumla Cader
- Centre for Human Virology and the School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Martina Vockerodt
- Centre for Human Virology and the School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Eszter Nagy
- Centre for Human Virology and the School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Patrik Flodr
- Laboratory of Molecular Pathology, Department of Pathology and Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacký University, 77900 Olomouc, Czech Republic
| | - Lee-Fah Yap
- Department of Oral Biology and Biomedical Sciences & Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Arjan Diepstra
- University of Groningen and University Medical Centre Groningen Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - Philip M Kluin
- University of Groningen and University Medical Centre Groningen Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - Stefano Rosati
- University of Groningen and University Medical Centre Groningen Department of Pathology and Medical Biology, Groningen, The Netherlands
| | - Paul Murray
- Centre for Human Virology and the School of Cancer Sciences, University of Birmingham, Birmingham, UK
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18
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Santos L, Azevedo K, Silva L, Oliveira L. Epstein-Barr virus in oral mucosa from human immunodeficiency virus positive patients. Rev Assoc Med Bras (1992) 2014; 60:262-9. [DOI: 10.1590/1806-9282.60.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/06/2013] [Indexed: 11/22/2022] Open
Abstract
Objective: the detection rate of Epstein-Barr virus (EBV) is higher in people living with human immunodeficiency virus (HIV). In an attempt to contribute to our epidemiological understanding of this coinfection and to investigate the activity of EBV in normal oral mucosa, we performed a cross-sectional study with HIV-positive patients. Methods: oral smears from 145 HIV-positive patients were collected between March 2010 and March 2011. Nested polymerase chain reaction (PCR) and reverse transcriptase-PCR (RT-PCR) were used to genotype EBV and to detect EBNA-2 expression, respectively. Results: EBV DNA was detected in 48.3% of the study participants, of whom 32.85% were EBV-1 and 45.71% were EBV-2 carriers. Additionally, 14.28% were coinfected with both types. EBNA-2 mRNA was expressed in 45.7% of the EBV -positive samples, including 20.0% with EBV-1 only, 20.0% with EBV-2 only and 1.4% with both genotypes. Immune status affected the overall EBV infection, and EBV-2 positivity was significantly correlated with sexual lifestyle of the participants. EBV co-infection with both viral types was dependent upon HIV viral load and the activity of the EBNA-2 gene. Conclusion: we report a high prevalence of active EBV in the oral mucosa of asymptomatic HIV-seropositive individuals. This study addresses the need for monitoring and treatment of HIV-infected patients with EBV reactivation.
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Sayeed S, Barnes I, Cairns BJ, Finlayson A, Ali R. Childhood cancer incidence in British Indians & Whites in Leicester, 1996-2008. PLoS One 2013; 8:e61881. [PMID: 23613964 PMCID: PMC3629092 DOI: 10.1371/journal.pone.0061881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 03/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND South Asians in England have an increased risk of childhood cancer but incidence by their individual ethnicities using self-assigned ethnicity is unknown. Our objective was to compare the incidence of childhood cancer in British Indians and Whites in Leicester, which has virtually complete, self-assigned, ethnicity data and the largest population of Indians in England. METHODS We obtained data on all cancer registrations from 1996 to 2008 for Leicester with ethnicity obtained by linkage to the Hospital Episodes Statistics database. Age-standardised incidence rates were calculated for childhood cancers in Indians and Whites as well as rate ratios, adjusted for age. RESULTS There were 33 cancers registered among Indian children and 39 among White children. The incidence rate for Indians was greater compared to Whites for all cancers combined (RR 1.82 (95% CI 1.14 to 2.89); p = 0.01), with some evidence of increased risk of leukaemia (RR 2.20 (0.95 to 5.07); p = 0.07), lymphoma (RR 3.96 (0.99 to 15.84); p = 0.04) and central nervous system tumours (RR 2.70 (1.00 to 7.26); p = 0.05). Rates were also higher in British Indian children compared to children in India. CONCLUSIONS British Indian children in Leicester had an increased risk of developing cancer compared to White children, largely due to a higher incidence of central nervous system and haematological malignancies.
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Affiliation(s)
- Shameq Sayeed
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, United Kingdom
| | - Isobel Barnes
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, United Kingdom
| | - Benjamin J. Cairns
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, United Kingdom
| | - Alexander Finlayson
- INDOX Cancer Research Network, Cancer Epidemiology Unit, Richard Doll Building, Oxford, United Kingdom
| | - Raghib Ali
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Oxford, United Kingdom
- Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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20
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21
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Clinical, molecular, and environmental risk factors for hodgkin lymphoma. Adv Hematol 2010; 2011:736261. [PMID: 21127715 PMCID: PMC2994062 DOI: 10.1155/2011/736261] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/11/2010] [Indexed: 12/14/2022] Open
Abstract
Epidemiological studies suggest unique occurrence patterns of Hodgkin lymphoma (HL) worldwide. In most Western countries there is a clear bimodal age distribution with an early peak in young adults followed by a second peak in older adults, particularly among males. In the Middle East and Asia, HL is more common in early childhood. There also are marked racial differences in the presentations of HL and HL subtypes, and particular single nucleotide polymorphisms (SNPs) have been identified as etiological factors suggesting that gene-gene and gene-environment interactions are involved. Personal health choices such as exercise and smoking may modify an individual's chances of developing HL. Numerous studies highlight the impact that exposure to Epstein-Barr virus and other environmental factors have on HL risk. Understanding the relative importance of each of these findings and their links to HL development and survival will help clinical researchers expand curative therapies and create preventative strategies for HL.
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22
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Souza EM, Baiocchi OCG, Zanichelli MA, Alves AC, Assis MG, Eiras DP, Dobo C, Oliveira JSR. Impact of Epstein-Barr virus in the clinical evolution of patients with classical Hodgkin's lymphoma in Brazil. Hematol Oncol 2010; 28:137-41. [PMID: 20128016 DOI: 10.1002/hon.933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Classical Hodgkin's Lymphoma (cHL) has been frequently associated with Epstein-Barr virus (EBV), which can be found in a latent pattern in Reed-Sternberg (RS) cells. However, the impact of the presence of EBV in RS cells and its prognosis are still controversial. We analysed the presence of EBV in RS cells and its influence in the clinical evolution of patients with cHL treated in two public hospitals in the city of São Paulo, Brazil. MATERIALS AND METHODS We selected 97 patients with cHL from 1994 to 2004. Patients were only included in this study if they had (1) >18 years, (2) negative HIV serology, (3) undergone similar chemotherapy protocols, (4) paraffin blocks available with enough material for systematic review and histological reclassification and for detection of EBV in RS cells by in situ hybridization and immunohistochemistry and (5) clinical, epidemiological and laboratorial parameters available after a thorough chart review. RESULTS EBV was identified in 52.5% of the cases. Mixed cellularity (MC) subtype was more common in EBV-related tumours (25.5%) (p=0.005). There was no difference on age, gender, stage and the presence of B symptoms between the two groups. The presence of EBV did not influence event free survival (EFS) (p=0.38) or overall survival (OS) (p=0.80) with a median follow-up of 80 months. CONCLUSION We demonstrate that the prevalence of EBV-related cHL in this Brazilian population is 52.5% and, that, the presence of EBV does not change the clinical evolution and OS of patients treated with similar chemotherapy protocols.
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Affiliation(s)
- Eni M Souza
- Federal University of São Paulo (UNIFESP), Hematology and Transfusion Service, São Paulo, SP, Brazil
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23
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Cader FZ, Kearns P, Young L, Murray P, Vockerodt M. The contribution of the Epstein-Barr virus to the pathogenesis of childhood lymphomas. Cancer Treat Rev 2010; 36:348-53. [DOI: 10.1016/j.ctrv.2010.02.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Abstract
Hodgkin's lymphoma (HL) has a unique and distinct history, epidemiology, treatment, and biology. A viral agent or infectious agent has long been considered as the etiologic agent and Epstein-Barr virus is the main candidate for the infectious agent causing HL; however, Epstein-Barr virus genome is found within the tumor in only about 20% to 40% of HL cases with a prior diagnosis of infectious mononucleosis. Recently, autoimmune and related conditions have drawn attention to a potential role for immune-related and inflammatory conditions in the etiology and pathogenesis of the malignancy. Evidence from multiply-affected families, a twin study, a case-control study, and population-based registry studies implicate genetic factors. Data from Eastern Asia and among Chinese immigrants in North America indicate increasing incidence trends for HL being associated with westernization. These results emphasize an interaction between environmental and genetic risk factors in HL.
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26
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Abstract
This review considers recent studies regarding the role of environmental factors in the etiology of childhood leukemia and lymphoma. Potential environmental risk factors identified for childhood leukemia include exposure to magnetic fields of more than 0.4 micro Tessla, exposure to pesticides, solvents, benzene and other hydrocarbons, maternal alcohol consumption (but only for certain genotypes), contaminated drinking water, infections, and high birth weight. The finding of space-time clustering and seasonal variation also supports a role for infections. There is little evidence linking childhood leukemia with lifetime exposure to ionizing radiation although fetal exposures to X-rays are associated with increased risk. Breast-feeding, consumption of fresh fruit and vegetables and having allergies all appear to be protective. Burkitt lymphoma (BL) is confined to areas of the world where malaria is endemic, with the additional involvement of the Epstein-Barr virus (EBV) as a co-factor. Environmental risk factors suggested for other types of non-Hodgkin lymphoma (NHL) include exposure to ionizing radiation (both lifetime and antenatal), pesticides, and, in utero exposure to cigarette smoke, benzene and nitrogen dioxide (via the mother). Hodgkin lymphoma (HL) is especially associated with higher levels of socioeconomic deprivation, but breast-feeding seems to confer lower risk. This is consistent with an infection or immune-response mediated etiology for HL.
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Affiliation(s)
- Richard J Q McNally
- School of Clinical Medical Sciences, Child Health, University of Newcastle Upon Tyne, UK.
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27
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Kapatai G, Murray P. Contribution of the Epstein Barr virus to the molecular pathogenesis of Hodgkin lymphoma. J Clin Pathol 2007; 60:1342-9. [PMID: 18042690 DOI: 10.1136/jcp.2007.050146] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Although the morphology of the pathognomonic Reed-Sternberg cells of Hodgkin lymphoma (HL) was described over a century ago, it was not until recently that their origin from B lymphocytes was recognised. The demonstration that a proportion of cases of HL harbour the Epstein-Barr virus (EBV) and that its genome is monoclonal in these tumours suggests that the virus contributes to the development of HL in some cases. This review summarises current knowledge of the pathogenesis of HL with particular emphasis on the association with EBV.
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Affiliation(s)
- G Kapatai
- The Cancer Research UK Institute for Cancer Studies, Medical School, University of Birmingham, Birmingham, UK
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28
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Jain RV, Mills PK, Parikh-Patel A. Cancer incidence in the south Asian population of California, 1988-2000. J Carcinog 2005; 4:21. [PMID: 16283945 PMCID: PMC1315316 DOI: 10.1186/1477-3163-4-21] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2005] [Accepted: 11/10/2005] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although South Asians (SA) form a large majority of the Asian population of U.S., very little is known about cancer in this immigrant population. SAs comprise people having origins mainly in India, Pakistan, Bangladesh and Sri Lanka. We calculated age-adjusted incidence and time trends of cancer in the SA population of California (state with the largest concentration of SAs) between 1988-2000 and compared these rates to rates in native Asian Indians as well as to those experienced by the Asian/Pacific Islander (API) and White, non-Hispanic population (NHW) population of California. METHODS Age adjusted incidence rates observed among the SA population of California during the time period 1988-2000 were calculated. To correctly identify the ethnicity of cancer cases, 'Nam Pehchan' (British developed software) was used to identify numerator cases of SA origin from the population-based cancer registry in California (CCR). Denominators were obtained from the U.S. Census Bureau. Incidence rates in SAs were calculated and a time trend analysis was also performed. Comparison data on the API and the NHW population of California were also obtained from CCR and rates from Globocan 2002 were used to determine rates in India. RESULTS Between 1988-2000, 5192 cancers were diagnosed in SAs of California. Compared to rates in native Asian Indians, rates of cancer in SAs in California were higher for all sites except oropharyngeal, oesophageal and cervical cancers. Compared to APIs of California, SA population experienced more cancers of oesophagus, gall bladder, prostate, breast, ovary and uterus, as well as lymphomas, leukemias and multiple myelomas. Compared to NHW population of California, SAs experienced more cancers of the stomach, liver and bile duct, gall bladder, cervix and multiple myelomas. Significantly increasing time trends were observed in colon and breast cancer incidence. CONCLUSION SA population of California experiences unique patterns of cancer incidence most likely associated with acculturation, screening and tobacco habits. There is need for early diagnosis of leading cancers in SA. If necessary steps are not taken to curb the growth of breast, colon and lung cancer, rates in SA will soon approximate those of the NHW population of California.
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Affiliation(s)
- Ratnali V Jain
- California Cancer Registry, Public Health Institute, Fresno, California, USA
- University of California, San Diego, Moores UCSD Cancer Center, Cancer Prevention and Control, La Jolla, California, USA
| | - Paul K Mills
- California Cancer Registry, Public Health Institute, Fresno, California, USA
- University of California, San Francisco, Fresno Medical Education Program, Fresno, California, USA
| | - Arti Parikh-Patel
- California Cancer Registry, Public Health Institute, Sacramento, California, USA
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29
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Peh SC, Nadarajah VS, Tai YC, Kim LH, Abdullah WAB. Pattern of Epstein-Barr virus association in childhood non-Hodgkin's lymphoma: Experience of University of Malaya Medical Center. Pathol Int 2004; 54:151-7. [PMID: 14989737 DOI: 10.1111/j.1440-1827.2003.01601.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The pattern of childhood non-Hodgkin's lymphoma (NHL) usually differs in adults. The most common subtypes are lymphoblastic, Burkitt's and anaplastic large cell lymphoma. Recent data indicate that a higher risk of developing lymphoma is associated in children of certain ethnic origins. The difference is probably related to the underlying etiological factors of these diseases, and Epstein-Barr virus (EBV) is a strong candidate. The present study aims to determine the disease pattern of childhood lymphomas in the University Hospital Kuala Lumpur, for a direct comparison to the reported data of adults from the same medical center. A total of 69 and 34 childhood NHL and Hodgkin's lymphomas, respectively, were retrieved. The most common subtypes were lymphoblastic (23 cases), Burkitt's (25 cases) and anaplastic large cell lymphomas (9 cases). Epstein-Barr virus association was more prevalent in B-cell (23%) than T-cell (12%) lymphomas. The most common EBV-associated tumor was Burkitt's lymphoma, and there was an increased risk of EBV association for Burkitt's lymphoma in Chinese patients. In conclusion, the pattern of childhood lymphoma in Malaysia is relatively similar to children elsewhere in the world. The EBV association of B- and T-NHL differs between children and adults from the same medical center because of differences in the subtype composition in these two age groups.
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Affiliation(s)
- Suat-Cheng Peh
- Department of Pathology, University of Malaya Medical Center, Kuala Lumpur, Malaysia.
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30
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Birch JM, Alston RD, Quinn M, Kelsey AM. Incidence of malignant disease by morphological type, in young persons aged 12–24 years in England, 1979–1997. Eur J Cancer 2003; 39:2622-31. [PMID: 14642924 DOI: 10.1016/j.ejca.2003.08.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cancer incidence data are generally presented in terms of primary site, but this method is inappropriate for cancers in young persons. We have used a morphology-based classification system to produce national incidence rates for cancers in persons aged 12-24 years by detailed diagnostic sub-type. The overall incidence rates for malignant disease in young persons aged 12-14, 15-19 and 20-24 years were 10.1, 14.4 and 22.6 per 100000 population, respectively. The three most frequent cancer types in 12-14-year-olds were leukaemias, lymphomas and central nervous system (CNS) tumours. In 15-19-year-olds, lymphomas were most frequent and leukaemias second with carcinomas third. In 20-24-year-olds, lymphomas were again most frequent, but carcinomas and germ cell tumours were second and third. There was also variation with age in the ratios of rates in males and females. These changing incidence patterns have aetiological implications and provide clues for future hypothesis-based research.
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Affiliation(s)
- J M Birch
- Cancer Research UK, Paediatric & Familial Cancer Research Group, Royal Manchester Children's Hospital, Stancliffe, Hospital Road, Manchester M27 4HA, UK.
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31
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Reiman A, Powell JE, Flavell KJ, Grundy RG, Mann JR, Parkes S, Redfern D, Young LS, Murray PG. Seasonal differences in the onset of the EBV-positive and -negative forms of paediatric Hodgkin's lymphoma. Br J Cancer 2003; 89:1200-1. [PMID: 14520445 PMCID: PMC2394289 DOI: 10.1038/sj.bjc.6601277] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this study, we have shown that there are seasonal differences in the onset of the (Epstein–Barr virus) EBV-positive and -negative forms of paediatric Hodgkin's lymphoma (HL). This suggests aetiological differences between the two forms of this disease. EBV-positive HL might be a rare consequence of primary EBV infection.
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Affiliation(s)
- A Reiman
- Department of Pathology, Division of Cancer Studies, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - J E Powell
- Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - K J Flavell
- Department of Pathology, Division of Cancer Studies, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - R G Grundy
- Department of Oncology, The Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - J R Mann
- Department of Oncology, The Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - S Parkes
- Department of Oncology, The Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - D Redfern
- Department of Pathology, The Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
| | - L S Young
- Cancer Research UK Institute for Cancer Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - P G Murray
- Department of Pathology, Division of Cancer Studies, The Medical School, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
- Division of Cancer Studies, The Medical School. E-mail:
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32
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Alexander FE, Lawrence DJ, Freeland J, Krajewski AS, Angus B, Taylor GM, Jarrett RF. An epidemiologic study of index and family infectious mononucleosis and adult Hodgkin's disease (HD): evidence for a specific association with EBV+ve HD in young adults. Int J Cancer 2003; 107:298-302. [PMID: 12949811 DOI: 10.1002/ijc.11156] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Infectious mononucleosis (IM) is an established risk factor for Hodgkin's disease (HD). A substantial minority (33%) of cases of HD have Epstein-Barr virus (EBV) DNA within the malignant cells (are EBV+ve). It is unclear whether risk after IM applies specifically to EBV+ve HD. We report the results of a population-based case-control study of HD in adults (n = 408 cases of classical HD, 513 controls) aged 16-74 years; the case series included 113 EBV+ve and 243 EBV+ve HD. Analyses compared total HD, EBV+ve HD and EBV-ve HD with the controls and EBV+ve HD with EBV-ve HD cases using, mainly, logistic regression. Regression analyses were adjusted for gender, age-group and socioeconomic status, and were performed for the whole age range and separately for young (< 35 years) and old adults (> or = 35 years); formal tests of effect modification by age were included. For the young adults, reported IM in index or relative was strongly and significantly associated with EBV+ve HD when compared to controls (odds ratio [OR] = 2.94, 95% confidence interval [CI]: 1.08-7.98 and OR = 5.22, 95% CI: 2.15-12.68, respectively). These results may be interpreted as indications that late first exposure to EBV increases risk of HD, especially in young adults; this applies primarily to EBV+ve HD.
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Affiliation(s)
- Freda E Alexander
- Department of Community Health, Public Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK.
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33
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Abstract
Epstein-Barr virus (EBV) is a ubiquitous human herpesvirus associated with the development of both lymphoid and epithelial tumours. As a common virus infection, EBV appears to have evolved to exploit the process of B cell development to persist as a life-long asymptomatic infection. However, the virus can contribute to oncogenesis as evidenced by its frequent detection in certain tumours, namely Burkitt's lymphoma (BL), post-transplant B cell lymphomas, Hodgkin's disease (HD) and nasopharyngeal carcinoma (NPC), and by its unique ability to efficiently transform resting B cells in vitro into permanently growing lymphoblastoid cell lines (LCLs). These transforming effects are associated with the restricted expression of EBV genes such that only a subset of so-called latent virus proteins are expressed in virus infected tumours and in LCLs. Distinct forms of EBV latency are manifest in the different tumours and these appear to be a vestige of the pattern of latent gene expression used by the virus during the establishment of persistent infection within the B cell pool. This review summarises our current knowledge of EBV latent gene function and how this relates to the role of the virus in the aetiology of different tumours.
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Affiliation(s)
- Lawrence S Young
- Cancer Research UK Institute for Cancer Studies, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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34
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Abstract
This review considers in detail the descriptive and aetiological epidemiology of Hodgkin's disease and non-Hodgkin's lymphoma (NHL), with attention to histological subcategories when the literature allows. The aetiology of Hodgkin's disease remains only partially understood. There is evidence that Epstein-Barr virus (EBV) may be involved in the causation of some cases, and clinical immune deficiency is a risk factor for a few, but the evidence is not entirely consistent and other factors may also be important in causing the EBV-associated cases of Hodgkin's disease. The cause of EBV-unassociated cases remains obscure. For NHL, although it has been shown that some cases are related to immune deficiency and chronic antigenic stimulation, and especially to EBV in the context of immune deficiency, the causation of the majority of cases remains unknown. The increasing incidence of NHL, other than that related to AIDS, is also essentially unexplained. Epidemiological investigation of the aetiology of NHL and Hodgkin's disease is making steady progress, however, and there remain leads to be followed that may result in a better understanding and hence prevention.
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Affiliation(s)
- A J Swerdlow
- Section of Epidemiology, Institute of Cancer Research, Brookes Lawley Building, Sutton, Surrey, UK.
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35
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Krugmann J, Tzankov A, Gschwendtner A, Fischhofer M, Greil R, Fend F, Dirnhofer S. Longer failure-free survival interval of Epstein-Barr virus-associated classical Hodgkin's lymphoma: a single-institution study. Mod Pathol 2003; 16:566-73. [PMID: 12808062 DOI: 10.1097/01.mp.0000071843.09960.bf] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We analyzed Epstein-Barr virus association in classical Hodgkin's lymphoma from a single center in Austria with special emphasis on the latent membrane protein1 gene configuration and clinical outcome. All 119 (65 male, 54 female) patients were treated from 1974 to 1999 in the Division of Hematology and Oncology at the Department of Internal Medicine, University of Innsbruck, Austria. The mean follow-up time was 122 months (range, 3-333 mo). Epstein-Barr virus was examined by latent membrane protein1 immunohistochemistry and by in situ hybridization for Epstein-Barr virus-encoded early ribonuclein acid transcripts. For assessment of the Epstein-Barr virus subtype (A/B) and latent membrane protein1 gene configuration, the polymerase chain reaction was employed. Fifty-four reactive tonsils were used as the control population. These results as well as clinical parameters such as age, gender, tumor stage, risk factors, and B symptoms were correlated with failure-free and overall survival. Latent membrane protein1 was detected in 31/119 (26%) classical Hodgkin's lymphoma, and Epstein-Barr virus subtyping was successful in 19 of the 31 virus-infected classical Hodgkin's lymphoma cases, as well as in 28 of 54 reactive tonsils. Subtype A was observed in all classical Hodgkin's lymphoma patients and in 26/28 (93%) tonsils. The 30-base pair latent membrane protein1 gene deletion was found in only 4/31 (13%) Epstein-Barr virus-associated classical Hodgkin's lymphoma as well as in 20/54 (37%) reactive tonsils. Patients with Epstein-Barr virus-associated classical Hodgkin's lymphoma showed a significantly longer mean time to first relapse of 99 months, as compared with 49 months for the Epstein-Barr virus-negative cases (P <.02), and were more frequent in those aged >45 years (P <.04). Epstein-Barr virus-associated classical Hodgkin's lymphoma were predominantly of the mixed-cellularity subtype and occurred more frequently in male patients, in patients with Stage III and IV, and in patients with B symptoms as well as risk factors. However, overall survival did not correlate with Epstein-Barr virus association. The 30-base pair latent membrane protein1 gene deletion had no influence on overall survival and failure-free survival time. Although the number of patients with this specific mutation was low, it further shows that an increased oncogenic potential of the latent membrane protein1 deletion variant is unlikely. This large single-center study demonstrates a low prevalence of Epstein-Barr virus positivity in classical Hodgkin's lymphoma in western Europe. In accordance with results of similar studies, the presence of Epstein-Barr virus has a beneficial effect on the length of failure-free survival despite the higher frequency of risk factors such as higher tumor stage or advanced age.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antigens, Viral/genetics
- Antigens, Viral/metabolism
- Biomarkers, Tumor/metabolism
- Child
- Child, Preschool
- Disease-Free Survival
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/metabolism
- Epstein-Barr Virus Infections/pathology
- Female
- Herpesvirus 4, Human/classification
- Herpesvirus 4, Human/genetics
- Herpesvirus 4, Human/isolation & purification
- Hodgkin Disease/metabolism
- Hodgkin Disease/pathology
- Hodgkin Disease/virology
- Humans
- Immunohistochemistry
- Male
- Middle Aged
- Polymerase Chain Reaction
- RNA, Neoplasm/analysis
- RNA, Viral/analysis
- Retrospective Studies
- Viral Matrix Proteins/genetics
- Viral Matrix Proteins/metabolism
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Affiliation(s)
- Jens Krugmann
- Institute of Pathology, University of Innsbruck, Austria
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36
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Abstract
Hodgkin's lymphoma (HL) is unusual among human malignancies in that the epidemiology suggests an infectious aetiology. The Epstein-Barr virus (EBV) is associated with a proportion of cases and this association is believed to be causal. In these cases the Hodgkin and Reed-Sternberg (HRS) cells express the EBV-encoded proteins LMP1 and LMP2, which can mimic CD40 and the B cell receptor, respectively, and therefore may play a critical role in facilitating the survival of HRS cells. EBV-associated and non-EBV-associated HL cases have different epidemiological features and recent data suggest that delayed exposure to EBV is a risk factor for the development of EBV-associated HL in young adults. We suggest that HL can be divided into four entities on the basis of EBV status and age at presentation, with three groups of EBV-associated cases and a single group of EBV-negative cases. The aetiology of the latter cases is obscure although involvement of an infectious agent(s) is suspected.
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Affiliation(s)
- R F Jarrett
- LRF Virus Centre, Institute of Comparative Medicine, Faculty of Veterinary Medicine, University of Glasgow, UK.
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