title: Impact of tumor Epstein-Barr virus status on presenting features and outcome in age-defined subgroups of patients with classic Hodgkin lymphoma: a population-based study.
abstract: The association between tumor Epstein-Barr virus (EBV) status and clinical outcome in Hodgkin lymphoma (HL) is controversial. This population-based study assessed the impact of EBV status on survival in age-stratified cohorts of adults with classic HL (cHL). Data from 437 cases were analyzed with a median follow-up of 93 months. Overall survival (OS) was significantly better for EBV-negative compared with EBV-positive patients (P < .001), with 5-year survival rates of 81% and 66%, respectively; disease-specific survival (DSS) was also greater for EBV-negative patients (P = .03). The impact of EBV status varied with age at diagnosis. In patients aged 16 to 34 years, EBV-associated cases had a survival advantage compared with EBV-negative cases, but differences were not statistically significant (P = .21). Among patients 50 years or older, EBV positivity was associated with a significantly poorer outcome (P = .003). Excess deaths occurred in EBV-positive patients with both early- and advanced-stage disease. In multivariate analysis of OS in the older patients, EBV status retained statistical significance after adjusting for the effects of sex, stage, and B symptoms (P = .01). Impaired immune status may contribute to the development of EBV-positive cHL in older patients, and strategies aimed at boosting the immune response should be investigated in the treatment of these patients.
authors.affiliation: Leukaemia Research Fund (LRF) Virus Centre, Institute of Comparative Medicine, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Ruth F
authors.initials: RF
authors.lastname: Jarrett
authors.forename: Gail L
authors.initials: GL
authors.lastname: Stark
authors.forename: Jo
authors.initials: J
authors.lastname: White
authors.forename: Brian
authors.initials: B
authors.lastname: Angus
authors.forename: Freda E
authors.initials: FE
authors.lastname: Alexander
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Krajewski
authors.forename: June
authors.initials: J
authors.lastname: Freeland
authors.forename: G Malcolm
authors.initials: GM
authors.lastname: Taylor
authors.forename: Penelope R A
authors.initials: PR
authors.lastname: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D004854:Herpesvirus 4, Human / Q000378:metabolism*; D006689:Hodgkin Disease / Q000401:mortality / Q000628:therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome