title: EBV-positive diffuse large B-cell lymphoma in young adults: is this a distinct disease entity?
abstract: BACKGROUND
  Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is defined only in adults older than 50 years. However, EBV-positive DLBCL can affect younger patients. We investigated the prevalence, clinical characteristics and survival outcomes of EBV-positive DLBCL in young adults.
  
  
  METHODS
  We analyzed patients with de novo DLBCL who were registered in the Samsung Medical Center (SMC) retrospective lymphoma cohort and prospective SMC Lymphoma Cohort Study I (ClinicalTrials.gov: NCT00822731).
  
  
  RESULTS
  A total of 571 cases were included in the analysis. The prevalence of EBV positivity was 6.7% (13/195) and 9.3% (35/376) in the young group (≤50 years) and in the elderly group (>50 years), respectively. EBV status was closely associated with unique unfavorable clinical characteristics [older age, more advanced stage, two or more sites of extranodal involvement, higher International Prognostic Index (IPI), and age-adjusted IPI risk] only in the elderly group. Poor prognostic impact of EBV positivity on overall survival was observed only in the elderly group [hazard ratio (HR) 2.86; 95% confidence interval (CI) 1.83-4.47; P < 0.001], but not in the young group (HR 1.17; 95% CI 0.35-3.89; P = 0.801).
  
  
  CONCLUSIONS
  A substantial proportion of EBV-positive DLBCL of the elderly can occur in young adults. EBV positivity of DLBCL in young adults was not associated with unfavorable clinical characteristics or worse outcomes. We suggest that EBV-positive DLBCL should not be confined only in the elderly and 'EBV-positive DLBCL in young adults' needs to be considered as a clinically distinct disease entity. ClinicalTrials.gov: NCT02060435.
authors.affiliation: Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul.
authors.forename: J Y
authors.initials: JY
authors.lastname: Hong
authors.affiliation: Department of Oncology.
authors.forename: D H
authors.initials: DH
authors.lastname: Yoon
authors.affiliation: Department of Oncology.
authors.forename: C
authors.initials: C
authors.lastname: Suh
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul.
authors.forename: J
authors.initials: J
authors.lastname: Huh
authors.affiliation: Department of Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea.
authors.forename: I-G
authors.initials: IG
authors.lastname: Do
authors.affiliation: Department of Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea.
authors.forename: I
authors.initials: I
authors.lastname: Sohn
authors.affiliation: Department of Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Jo
authors.affiliation: Department of Samsung Cancer Research Institute, Samsung Medical Center, Seoul, Korea Department of Biostatistics and Bioinformatics, Duke University, Durham, USA.
authors.forename: S-H
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Pathology.
authors.forename: M E
authors.initials: ME
authors.lastname: Hong
authors.affiliation: Department of Pathology.
authors.forename: H
authors.initials: H
authors.lastname: Yoon
authors.affiliation: Department of Pathology.
authors.forename: Y H
authors.initials: YH
authors.lastname: Ko
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea wskimsmc@skku.edu.
authors.forename: W S
authors.initials: WS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult
keywords: DLBCL; Ebstein–Barr virus; young adults