title: Clinical characteristics and treatment outcome in a Taiwanese population of patients with Epstein-Barr virus-positive diffuse large B-cell lymphoma.
abstract: OBJECTIVE
  Epstein-Barr virus-positive diffuse large B-cell lymphoma is a provisional entity in the 2008 World Health Organization classification of tumors of hematopoietic and lymphoid tissues. Reports on the characteristics and clinical outcome of this disease in different geographic regions showed great disparities.
  
  
  METHODS
  To define the clinical characteristics as well as the prognostic impact of Epstein-Barr virus infection on diffuse large B-cell lymphoma in Taiwan, we retrospectively investigated the Epstein-Barr virus status of 89 patients with newly diagnosed diffuse large B-cell lymphoma in our institute.
  
  
  RESULTS
  Using a cutoff point of positive nuclear staining of Epstein-Barr virus-encoded RNA-1-in situ hybridization in ≥20% of the examined cells, we identified 15 cases (16.9%) of the entire study cohort as Epstein-Barr virus-positive diffuse large B-cell lymphoma. The clinical and laboratory features were not different between Epstein-Barr virus-positive and -negative diffuse large B-cell lymphoma patients. Univariate analysis showed patients with diffuse large B-cell lymphoma that were either Epstein-Barr virus-positive or had activated B-cell-like features had an inferior overall survival. Older age, advanced stage and lymphoma with activated B-cell-like features or Epstein-Barr virus-encoded RNA positivity were independent prognostic factors affecting overall survival on multivariate analysis. Patients with two or three of these adverse-risk factors were considered high risk and fared far worse than patients with no or only one adverse factor.
  
  
  CONCLUSIONS
  Taken together, we demonstrated that a higher frequency of Epstein-Barr virus association was detected in a Taiwanese cohort of diffuse large B-cell lymphoma patients, and Epstein-Barr virus-encoded RNA positivity was shown to add important prognostic value in these patients.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan.
authors.forename: Chang-Hsien
authors.initials: CH
authors.lastname: Lu
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital, Chiayi.
authors.forename: Kam-Fai
authors.initials: KF
authors.lastname: Lee
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi College of Medicine, Chang Gung University, Tao-Yuan, Taiwan ccchen1968@gmail.com jrhaulung@gmail.com.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi.
authors.forename: Yi-Yang
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi.
authors.forename: Cih-En
authors.initials: CE
authors.lastname: Huang
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi.
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Tsai
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi.
authors.forename: Hsing-Yi
authors.initials: HY
authors.lastname: Tsou
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi.
authors.forename: Hui-Ju
authors.initials: HJ
authors.lastname: Chou
authors.affiliation: Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Miao-Fen
authors.initials: MF
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan.
authors.forename: Pin-Tsung
authors.initials: PT
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi Graduate Institute of Clinical Medical Sciences, Chang Gung University, Tao-Yuan College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Kuan-Der
authors.initials: KD
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chang Gung Memorial Hospital, Chiayi ccchen1968@gmail.com jrhaulung@gmail.com.
authors.forename: Jrhau
authors.initials: J
authors.lastname: Lung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D004854:Herpesvirus 4, Human; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan; D016896:Treatment Outcome
keywords: Epstein–Barr virus; diffuse large B-cell lymphoma; non-Hodgkin's lymphoma; prognosis