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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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Bhurani D, Nair R, Rajappa S, Rao SA, Sridharan N, Boya RR, Raman GS, Menon H, Seshachalam A, Nimmagadda R. Real-World Outcomes of Hodgkin Lymphoma: A Multi-Centric Registry From India. Front Oncol 2022; 11:799948. [PMID: 35223455 PMCID: PMC8881143 DOI: 10.3389/fonc.2021.799948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundHodgkin’s lymphoma (HL) is one of the most curable malignancies with a 5-year survival of over 80%. Most published literature from low-middle income countries comes from single institute experience.MethodologyThe OncoCollect Lymphoma group registry was set up in 2017 and has 9 major participating sites across India. Data of newly diagnosed classical HL (CHL) patients, treated between 2011 and 2017, were collected using OncoCollect software. The clinical features, subtypes, prognostic stratification, treatment patterns, response to first-line treatment, and 5-year outcomes were analyzed. All statistical analysis was done using Microsoft R Open statistical software linked to OncoCollect software.ResultsThere were 939 newly diagnosed CHL patients with a median age of 38 (range, 18–99) years at presentation. The male-to-female ratio was 2.07:1. Histological subtypes included mixed cellularity, CHL (MC, CHL), nodular sclerosis, CHL (NS, CHL), lymphocyte-rich, CHL (LR, CHL), and lymphocyte-depleted, CHL (LD, CHL), in 60.60%, 26.94%, 9.80%, and 2.66%, respectively. At presentation, 50.43% had B symptoms and 53.35% had advanced disease. 29.71% of advanced-stage patients had high Hodgkin IPI score. 79% and 21% of patients received 1st-line treatment with chemotherapy alone or combined modality treatment with chemotherapy and radiotherapy. The most common first-line chemotherapy was ABVD-based regimen (94.68%). The overall response rate was 93.48%. Complete response rates among early-stage favorable and unfavorable risk groups were 92.73% and 86.79%, and those among advanced-stage low- and high-risk groups were 76.64% and 69.78%, respectively. The median relapse-free follow-up duration was 51 months (IQR 22–69). A significant difference was found in 5-year EFS between the early- and advanced-stage disease 83.53% and 73.55% (p = 0.00087), respectively. Similarly, significant difference was found in EFS among early-stage patients treated with a combination of 4-cycle chemotherapy and radiotherapy vs. chemotherapy alone 88.57% and 66.33% (p = 0.0042), respectively.ConclusionsIn this large cohort from India, survival of patients with HL was comparable to the developed world. With a median follow-up of 51 months, the 5-year EFS and OS of all patients were 78.24% and 83.63%, respectively.
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Affiliation(s)
- Dinesh Bhurani
- Department of Haematology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
- *Correspondence: Dinesh Bhurani,
| | - Reena Nair
- Department of Haematology, Tata Medical Centre, Kolkata, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Suparna Ajit Rao
- Department of Medical Oncology, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | - Rakesh Reddy Boya
- Department of Medical Oncology, Mahatama Gandhi Cancer Hospital and Research Center, Visakhapatnam, India
| | - Ganapathi S. Raman
- Department of Medical Oncology, Kumaran Hospital Private Ltd., Chennai, India
| | - Hari Menon
- Department of Medical Oncology, CyteCare Cancer Hospitals, Bengaluru, India
| | | | - Ramesh Nimmagadda
- Department of Medical Oncology, Apollo Cancer Institute, Chennai, India
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Usha MK, Jahan JA, Islam SRU, Begum F, Ahsan CR, Yasmin M. Evaluation of plasma Epstein-Barr virus DNA as a biomarker for Epstein-Barr virus-associated Hodgkin lymphoma. SAGE Open Med 2021; 9:20503121211054991. [PMID: 34733516 PMCID: PMC8559190 DOI: 10.1177/20503121211054991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: Epstein–Barr virus is a tumorigenic virus and has been extensively studied as a causative agent for Hodgkin lymphoma. Although immunostaining of the tumor biopsy is the standard method for diagnosis of Epstein–Barr virus-driven Hodgkin lymphoma, the invasiveness of the procedure renders it difficult and less desirable for the patients. Therefore, we designed this study to evaluate the efficiency of plasma Epstein–Barr virus DNA detection as an alternative diagnostic and prognostic method for Epstein–Barr virus–associated Hodgkin lymphoma. Methods: This analytical cross-sectional study was conducted during March 2017 to December 2018 including 43 Hodgkin lymphoma patients diagnosed histopathologically followed by the latent membrane protein-1 immunohistochemistry to determine their Epstein–Barr virus association. Plasma Epstein–Barr virus DNA in these samples was measured using quantitative polymerase chain reaction (qPCR). Results: Of total, 29 (67.44%) patients tested positive for plasma Epstein–Barr virus DNA. On comparing results of latent membrane protein-1 immunohistochemistry (IHC) with plasma Epstein–Barr virus DNA, plasma Epstein–Barr virus DNA was found in 25 of 30 patients with latent membrane protein-1 expression and 4 of 13 patients without latent membrane protein-1 expression. The sensitivity and the specificity of plasma Epstein–Barr virus DNA detection with respect to latent membrane protein-1 IHC were found to be 83.33% and 69.23%, respectively (p = 0.0014). Conclusion: Determination of plasma Epstein–Barr virus DNA was found to be highly sensitive and specific in characterizing Epstein–Barr virus–associated Hodgkin lymphoma, suggesting that this diagnostic method holds promise as an alternative and more convenient method of diagnosis compared with tissue biopsy.
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Affiliation(s)
| | - Jasmine Akhter Jahan
- Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Sm Rashed Ul Islam
- Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Ferdousy Begum
- Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | | | - Mahmuda Yasmin
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh
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Rani P, Jain M, Verma N, Kumar A, Jain A, Tripathi AK, Kumar A. Epstein-Barr Virus Expression in Classic Hodgkin Lymphoma in an Indian Cohort and its Association with Clinical and Histomorphological Parameters. Indian J Hematol Blood Transfus 2020; 37:372-378. [PMID: 34267454 DOI: 10.1007/s12288-020-01359-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022] Open
Abstract
Epstein Barr virus (EBV) associated Hodgkin lymphoma (HL) has been defined as cases with clonal EBV infection, EBV genome and gene products in the Reed Sternberg cells. We evaluated the prevalence and clinico-pathological association of EBV in North Indian HL patients. Eighty-eight cases of histologically confirmed classic HL were evaluated for EBV by both IHC expression of LMP1 and real time PCR on formalin fixed lymph node tissue. The expression pattern was analyzed for any association with clinical and histomorphological parameters. Nodular sclerosis subtype was seen in 79.5% patients and mixed cellularity was seen in the remaining patients. Ninety percent of the cases were positive for EBV. The detection rate of EBV by IHC was higher. The EBV positive cases presented with higher disease stage (p < 0.05). The presence of histomorphological features like granuloma formation (5/5), atypical lymphocytes (8/8), histiocyte clusters (26/28), large area of necrosis (11/12), less prominent inflammatory response (25/27) was associated with EBV positivity (p > 0.05). In our study population a high proportion of HL cases showed positivity for EBV indicating a pathogenic role. The positivity was independent of age, gender and histological subtype. Further evaluation of EBV positivity in modulation of tumor immunity may provide insights into variable treatment outcome in EBV positive cases.
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Affiliation(s)
- Preeti Rani
- Department of Pathology, King George's Medical University, Lucknow, 226003 India
| | - Mili Jain
- Department of Pathology, King George's Medical University, Lucknow, 226003 India
| | - Nishant Verma
- Department of Paediatrics, King George's Medical University, Lucknow, India
| | - Archana Kumar
- Department of Paediatrics, King George's Medical University, Lucknow, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow, India
| | - Anil Kumar Tripathi
- Department of Clinical Hematology, King George's Medical University, Lucknow, India
| | - Ashutosh Kumar
- Department of Pathology, King George's Medical University, Lucknow, 226003 India
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Cheriyalinkal Parambil B, Narula G, Dhamne C, Roy Moulik N, Shet T, Shridhar E, Gujral S, Shah S, Laskar S, Khanna N, Banavali S. Assessment of tumor Epstein-Barr Virus status and its impact on outcomes in intermediate and high-risk childhood classic Hodgkin Lymphoma treated at a tertiary cancer center in India. Leuk Lymphoma 2020; 61:3217-3225. [PMID: 32729791 DOI: 10.1080/10428194.2020.1800005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Indian studies on EBV in childhood classic Hodgkin Lymphoma (cHL) have mainly analyzed the epidemiology of EBV-positive [EBV(+)HL] or negative HL [EBV(-)HL], with limited data on outcomes. We studied a large cohort of children with intermediate and high-Risk cHL for tumor EBV status and its impact on outcomes retrospectively. Of evaluable 189 patients, 84.7% had EBV(+)HL. Positive status was significantly associated with age ≤ 10 years (p < .001), males (p = .015), non-Nodular Sclerosis (NS) histology (p = .004) and inversely with bulky-mediastinal disease (p < .001). At a median follow-up of 29-months (range1-75), 3-year Event-Free Survival (EFS) for EBV(+)HL and EBV(-)HL was 93.6%(95%CI:89.8%-97.5%), 81.1%(95%CI:67.2%-97.9%), (p = .048) and Overall Survival (OS) was 94.9%(95%CI:91.6%-98.4%), 84.6%(95%CI:71.5%-100%), (p = .075) respectively. Three-year EFS was better in males (HR-0.267,95%CI:0.078-0.916, p = .036) in EBV(+)HL and in patients with serum-albumin > 3g/dL (HR-0.117,95%CI:0.019-0.705, p = .019) in EBV(-)HL. EBV is associated with most of intermediate and high-risk childhood cHL, occurs in younger male patients with non-NS histology, with reduced incidence of bulky-mediastinal disease and favorable survival in childhood cHL.
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Affiliation(s)
| | - Gaurav Narula
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Chetan Dhamne
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nirmalya Roy Moulik
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Epari Shridhar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shripad Banavali
- Department of Pediatric Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, India
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Liang K, Wang J, Wang Y, Zhou Z, Ge S, Mei S, Li H, Jing X, Zhang C. The histologic, immunohistochemical, and genetic features of classical Hodgkin lymphoma and anaplastic large cell lymphoma with aberrant T-cell/B-cell antigen expression. Hum Pathol 2019; 84:309-320. [DOI: 10.1016/j.humpath.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/27/2018] [Accepted: 10/04/2018] [Indexed: 11/25/2022]
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Meti N, Esfahani K, Johnson NA. The Role of Immune Checkpoint Inhibitors in Classical Hodgkin Lymphoma. Cancers (Basel) 2018; 10:cancers10060204. [PMID: 29914088 PMCID: PMC6025119 DOI: 10.3390/cancers10060204] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/04/2018] [Accepted: 06/12/2018] [Indexed: 01/06/2023] Open
Abstract
Hodgkin Lymphoma (HL) is a unique disease entity both in its pathology and the young patient population that it primarily affects. Although cure rates are high, survivorship can be linked with significant recent long-term morbidity associated with both chemotherapy and radiotherapy. The most significant advances have been with the use of the anti-CD30-drug conjugated antibody brentuximab vedotin (BV) and inhibitors of program death 1 (PD-1). HL is genetically wired to up-regulate program death ligand 1 (PD-L1) in >95% of cases, creating a state of so-called “T cell exhaustion”, which can be reversed with immune checkpoint-inhibitor blockade. The overall and complete response rates to PD-1 inhibitors in patients with relapsed or refractory HL are 70% and 20%, respectively, with a long median duration of response of ~16 months. In fact, PD-1 inhibitors can benefit a wide spectrum of relapsed HL patients, including some who have “progressive disease” by strict response criteria. We review the biology of HL, with a focus on the immune micro-environment and mechanisms of immune evasion. We also provide the rationale supporting the use of PD-1 inhibitors in HL and highlight some of the challenges of monitoring disease response in patients treated with this immunotherapy.
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Affiliation(s)
- Nicholas Meti
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
| | - Khashayar Esfahani
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
| | - Nathalie A Johnson
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
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Kafita D, Kaile T, Malyangu E, Tembo R, Zulu E, Chisanga C, Kalonda A, Samutela M, Polepole P, Kwenda G. Evidence of EBV infection in lymphomas diagnosed in Lusaka, Zambia. Pan Afr Med J 2018; 29:181. [PMID: 30061959 PMCID: PMC6061862 DOI: 10.11604/pamj.2018.29.181.11847] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/02/2018] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Epstein-Barr virus (EBV) is a ubiquitous virus that infects more than 90% of the world's population, and is implicated in lymphoma pathogenesis. However, in Zambia during the diagnosis of these lymphomas, the association of the virus with the lymphomas is not established. Since most patients with lymphomas have poor prognosis, the identification of the virus within the lymphoma lesion will allow for more targeted therapy. The aim of this study was to provide evidence of the presence of the EBV in lymphomas diagnosed at the University Teaching Hospital (UTH) in Lusaka, Zambia. METHODS One hundred and fifty archival formalin-fixed paraffin embedded suspected lymphoma tissues stored over a 4-year period in the Histopathology Laboratory at the UTH in Lusaka, Zambia, were analysed. Histological methods were used to identify the lymphomas, and the virus was detected using Polymerase Chain Reaction (PCR). Subtyping of the virus was achieved through DNA sequencing of the EBNA-2 region of the viral genome. Chi square or fisher's exact test was used to evaluate the association between EBV status, type of lymphoma and gender. RESULTS The majority of the lymphomas identified were non-Hodgkin's lymphoma (NHL) (80%) followed by Hodgkin's lymphoma (HL) (20%). EBV was detected in 51.8% of the cases, 54.5% of which were associated with NHL cases, while 40.9% associated with HL cases. The predominant subtype of the virus in both types of lymphomas was subtype 1. One of the lymphoma cases harboured both subtype 1 and 2 of the virus. CONCLUSION This study showed that EBV is closely associated with lymphomas. Therefore, providing evidence of the presence of the virus in lymphoma tissues will aid in targeted therapy. To our knowledge this is the first time such data has been generated in Zambia.
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Affiliation(s)
- Doris Kafita
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Trevor Kaile
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Evans Malyangu
- Department of Pathology, Maina Soko Military Hospital, Lusaka, Zambia
| | - Rabecca Tembo
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Ephraim Zulu
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Chrispin Chisanga
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Annie Kalonda
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mulemba Samutela
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Pascal Polepole
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Geoffrey Kwenda
- Department of Biomedical Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
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Hashmi AA, Hussain ZF, Hashmi KA, Zafar MI, Edhi MM, Faridi N, Khan M. Latent membrane protein 1 (LMP1) expression in Hodgkin lymphoma and its correlation with clinical and histologic parameters. World J Surg Oncol 2017; 15:89. [PMID: 28427406 PMCID: PMC5397827 DOI: 10.1186/s12957-017-1147-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background Hodgkin lymphoma is one of the most prevalent lymphoproliferative disorders in Pakistan; however, no risk factors for this disease have yet to be established in our population. Epstein–Barr virus (EBV) is a well-known risk factor for Hodgkin lymphoma in endemic regions of the world; however, frequency of its association in our population has not been widely studied. Latent membrane protein 1 (LMP1) expression by immunohistochemistry (IHC) is a surrogate marker of EBV in Hodgkin lymphoma. Therefore, we aimed to evaluate the frequency of expression of LMP1 in cases of Hodgkin lymphoma at our institute and its correlation with other clinical and histologic parameters. Methods The study included 66 cases of Hodgkin lymphoma diagnosed at Liaquat National Hospital over a duration of 2 years from January 2014 to December 2015. The slides and blocks of all cases were retrieved, and representative blocks were selected for LMP1 by IHC. LMP1 expression of >10% of cells was considered as positive expression and correlated with histologic subtypes and clinical parameters like age, gender, and site of involvement. Results The mean age of patients was 35.11 (+20.22). LMP1 expression was found in 68.1% (45/66) of cases of Hodgkin lymphoma. Mean age of the patients with LMP1 expression was 32.04 (+21.02). LMP1 expression was found in 40% cases of lymphocyte-rich, 66.7% of lymphocyte-depleted, 73.9% of mixed cellularity, 66.7% of nodular sclerosis, and 73.7% of classic Hodgkin lymphoma, NOS. No significant correlation of LMP1 expression with any clinical or histological parameter could be established in our studied patient population. Conclusions A high frequency of expression of LMP1 is seen in cases of Hodgkin lymphoma at our setup comparable to endemic regions of the world; therefore, preventive and treatment protocols should be designed accordingly.
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Affiliation(s)
- Atif Ali Hashmi
- Department of Pathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Zubaida Fida Hussain
- Department of Pathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Kashif Ali Hashmi
- Department of Cardiology, Chaudhry Pervaiz Elahi Institute of Cardiology, Multan, Pakistan
| | - Muhammad Irfan Zafar
- Department of Biostatistics, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | - Naveen Faridi
- Department of Pathology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Mehmood Khan
- Department of Medicine, Dhaka University, Dhaka, Bangladesh.
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Prevalence and Prognostic Significance of Epstein–Barr Virus Infection in Classical Hodgkin's Lymphoma: A Meta-analysis. Arch Med Res 2014; 45:417-31. [DOI: 10.1016/j.arcmed.2014.06.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 06/04/2014] [Indexed: 12/21/2022]
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Sinha M, Rao CR, Shafiulla M, Appaji L, Bs AK, Sumati BG, Avinash T, Jayshree RS. Cell-free epstein-barr viral loads in childhood hodgkin lymphoma: a study from South India. Pediatr Hematol Oncol 2013; 30:537-43. [PMID: 23756088 DOI: 10.3109/08880018.2013.796026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cell-free Epstein-Barr viral (EBV) DNA is detectable in plasma of patients with EBV-related lymphomas. The aim of this study was to evaluate the utility of plasma EBV DNA as a biomarker of EBV association in childhood Hodgkin lymphoma (HL). Furthermore, an attempt was made to evaluate the effectiveness of viral quantitation for assessing response to chemotherapy. Thirteen cases of childhood HL were included in this study. All 13 cases were EBV associated as reflected by expression of EBV LMP1 in the tumor specimen. Eighty-five percent had detectable EBV DNA levels; viral loads ranging from 2.9 to 156.2 × 10³ copies/ml (mean 29 × 10³ copies/ml); while in 2 patients and 30 controls tested, viral DNA was undetectable. In four patients, follow-up samples were available after three cycles of chemotherapy; all had EBV DNAemia prior to chemotherapy but undetectable EBV DNA posttherapy. This corroborated with complete response in these four patients. Plasma EBV viral load quantification maybe a useful tool for detecting EBV association with lymphomas and in monitoring response to treatment in childhood HL in centers with limited resources, more so in India where majority of childhood HL is likely to be EBV associated. This is the first Indian study estimating plasma EBV viral loads in HL.
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Affiliation(s)
- Mahua Sinha
- Departments of Microbiology, Kidwai Memorial Institute of Oncology, Bengaluru, India.
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Hodgkin's lymphoma--long-term outcome: an experience from a tertiary care cancer center in North India. Ann Hematol 2011; 90:1153-60. [PMID: 21625999 DOI: 10.1007/s00277-011-1262-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
Limited information is available from developing countries on long-term outcome of patients with Hodgkin's lymphoma (HL). Between January 1998 and December 2005, 262 patients (age ≥15 years) underwent treatment. Patients' median age was 30 years, ranging from 15 to 72 years. Male to female ratio was 2.8:1. B symptoms were present in 64% of patients. Seventy percent of patients had stage III and IV disease. Mixed cellularity (52.3%) was the most common histology followed by nodular sclerosis (38%). ABVD chemotherapy was used in 85% of the patients, and 50% received radiotherapy as consolidation. Following treatment 92% of patients achieved complete response. Five-year freedom from treatment failure (FFTF) and overall survival rate are 78.3% and 86.6% ± 0.02% (95% CI 80.0-93.2%), respectively. Stage at presentation, number of lymph node regions involved (≥3 vs ≤2), presence of B symptoms, and serum albumin (≥40 vs <40 g/L) were important determinants of FFTF. In a subset analysis of stage I and II HL patients, presence of bulky disease and pure infradiaphragmatic disease was associated with inferior outcome. On multivariate analysis involvement of three or more number of lymph node regions was a significant predictor of inferior freedom from treatment failure survival (hazard ratio 2.2, p < 0.01). Our analysis confirms excellent outcome for patients of Hodgkin's lymphoma with results comparable to developed countries.
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Audouin J, Diebold J, Nathwani B, Ishak E, Maclennan K, Mueller-Hermelink HK, Armitage JO, Weisenburger DD. Epstein-Barr virus and Hodgkin's lymphoma in Cairo, Egypt. J Hematop 2010; 3:11-8. [PMID: 21625283 DOI: 10.1007/s12308-010-0059-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 04/16/2010] [Indexed: 11/26/2022] Open
Abstract
Fifty-five consecutive cases of Hodgkin's lymphoma (HL), collected between 1996 and 1998 from Cairo, Egypt, were histologically subtyped, phenotyped, and then studied for the presence of Epstein-Barr virus (EBV). We used immunohistochemical stains for EBV latent membrane protein 1 (LMP-1) and in situ hybridization stains for EBV-encoded small RNA (EBER-1) transcripts. Forty-five cases (82%) had classic HL (cHL), and ten cases (18%) had nodular lymphocyte predominant HL (NLPHL), with each group expressing its typical phenotype. LMP-1 stains were positive in 63% and 0% of cHL and NLPHL cases, respectively. EBER-positive Reed-Sternberg cells and variants were also present in 62% and 0% of each group, respectively. The cHL cases showed variable EBER positivity: nodular sclerosis, 58%; mixed cellularity, 100%; lymphocyte depletion, 100%; and unclassifiable, 67%. Our findings are similar to those from other developing countries and point towards a pathogenic role of EBV in cHL.
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Dinand V, Dawar R, Arya LS, Unni R, Mohanty B, Singh R. Hodgkin's lymphoma in Indian children: prevalence and significance of Epstein-Barr virus detection in Hodgkin's and Reed-Sternberg cells. Eur J Cancer 2006; 43:161-8. [PMID: 17113770 DOI: 10.1016/j.ejca.2006.08.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2006] [Accepted: 08/21/2006] [Indexed: 11/17/2022]
Abstract
AIM This study was done to document the prevalence of Epstein-Barr virus (EBV) in Hodgkin's lymphoma (HL) in children of North India. METHODS 145 previously untreated children diagnosed with HL from 1991 to 2003 were included. Lymph node (LN) biopsies were studied and classified using World Health Organisation (WHO) classification. EBV detection was done by immunohistochemistry (IHC) and in situ hybridisation (ISH) in 145 cases and 25 age- and sex-matched controls. Patients were treated with chemotherapy alone. RESULTS EBV was detected by IHC in 131 (90.3%) cases and by ISH in 126 (93.3%) out of 135 cases, and in none of the controls examined. With IHC and ISH combined, EBV positivity was seen in 96.6% and was significantly associated with younger age (p=0.012) and lower socioeconomic level (p=0.007). EBV status had no implication on treatment response and survival. CONCLUSION EBV detection in 96.6% of childhood HL in a population with almost universal EBV seroconversion, and in none of the control lymph nodes, suggests a causative role of EBV in most cases of Indian childhood HL.
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Affiliation(s)
- Veronique Dinand
- Department of Paediatrics, Division of Paediatric Oncology, All India Institute of Medical Sciences, New Delhi 110 029, India.
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