Hodgkin Lymphoma in Pakistan: An Analysis of Subtypes and their Correlation with Epstein Barr Virus

Fatima, Samia;Ahmed, Rashida;Ahmed, Arsalan

  • Published : 20110600

Abstract

The epidemiology of Hodgkin lymphoma (HL) shows a wide geographic variation with regard to age, gender, histological subtypes and their association with Epstein-Barr virus. The proportion of EBV positive cases appears higher in developing than in developed countries. EBV is a common infection in Pakistan due to poor socioeconomic conditions, but reports regarding HL subtypes have been rather selective. Our aims were to establish the relative frequencies of the five subtypes of Hodgkin lymphoma, to determine their associations with Epstein-Barr virus, and finally to establish whether such association follows patterns seen in developing or developed countries. Among 100 cases, the male: female ratio was 4.5:1, with an age range of 4-82 years and an average of 26.6 years. Similar to the subtype distribution in developing countries, mixed cellularity was the commonest 57%, followed by nodular sclerosis 35%, lymphocyte rich 6% and nodular lymphocyte predominant 2 %. EBV-LMP1 staining was demonstrated in 41/57 (71%) of the mixed cellularity and the 19/35 (54.2%) of nodular sclerosis subtypes. All 6 cases of lymphocyte rich and 2 cases of nodular lymphocyte predominant were negative for EBV-LMP 1. Speculation about prognostic effects of EBV infection on the course of HL are tempting. Thus the EBV-positive HL could in the future prove to be an excellent candidate for targeted cellular immunotherapy.

Keywords

References

  1. Akram M, Cheema MH, Sana S, et al (2001). Hodgkin's Disease: Analysis of 75 patients. J Coll Physicians Surg Pak, 11, 702-5.
  2. Chang KC, Khen NT, Jones D, et al (2005). Epstein-Barr virus is associated with all histological subtypes of Hodgkin lymphoma in Vietnamese children with special emphasis on the entity of lymphocyte predominance subtype. Hum Pathol, 36, 747-55. https://doi.org/10.1016/j.humpath.2005.05.003
  3. Claviez A, Tiemann M, Luders H, et al (2005). Impact of latent Epstein-Barr virus infection on outcome in children and adolescents with Hodgkin's Lymphoma. J Clin Oncol, 23, 4048-56. https://doi.org/10.1200/JCO.2005.01.701
  4. Dinand V, Arya LS. (2006). Epidemiology of childhood Hodgkin's disease: Is it different in developing countries?. Indian Pediatrics, 43, 141-5.
  5. Jaffe ES, Harris NL, Stein H, et al (2001). Tumors of hematopoietic and lymphoid tissues. Pathology and Genetics, World Health Organization Classification of tumors, IARC Press, Lyon.
  6. Jarrett RF, Stark GL, White J, et al (2003). 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. Blood, 106, 2444-51.
  7. Karnik S, Srinavasan B, Nair S (2003). Hodgkin's lymphoma: immunohistochemical features and association with EBV LMP-1 from a South Indian Hospital. Pathology, 35, 207-11. https://doi.org/10.1080/0031302031000123164
  8. Khan G, Norton AJ, Slavin G, (1993). Epstein Barr virus in Hodgkin's disease: Relation to age and subtype. Cancer, 71, 3124-9. https://doi.org/10.1002/1097-0142(19930515)71:10<3124::AID-CNCR2820711038>3.0.CO;2-J
  9. Khan HI, Abdullah A, Saerun Nisa, (2005). Pattern of Hodgkin's lymphoma in children. Pakistan Ped J, 29,145-9.
  10. Kumar V, Abbas AK, Fausto N, (2004) Pathologic Basis of Disease. 9th ed Elsevier Philadelphia (Pennsylvania) p. 686-90.
  11. Lukes RJ, Craver LF, Hall TC, et al (1996). Report of Nomenclature Committee. Cancer Res, 16, 1311.
  12. Makar RR, Saji T, Junaid TA. (2003) Epstein-Barr virus expression in Hodgkin's lymphoma in Kuwait. Pathol Oncol Res, 9, 159-65. https://doi.org/10.1007/BF03033730
  13. Matteo ED, Baron AV, Chabay P, et al (2003). Comparison of Epstein Barr virus presence in Hodgkin's lymphoma in pediatric versus adult Argentine patients. Arch Pathol Lab Med, 127, 1325-9.
  14. Morente MM, Piris MA, Abraira V (1997). Adverse clinical outcome in Hodgkin's disease is associated with loss of retinoblastoma protein expression, high Ki67 proliferation index, and absence of Epstein-Barr virus-latent membrane protein 1 expression. Blood, 90, 2429-36.
  15. Murray PG, Billingham LI, Hassan TH, et al (1999). Effect of Epstein -Barr virus infection on response to chemotherapy and survival in Hodgkin's disease. Blood, 94, 442-7.
  16. Naresh KN, Johnson J, Srinivas V, et al (2000). Epstein-Barr virus association in classical Hodgkin's disease provides survival advantage to patients and correlates with higher expression of proliferation markers in Reed-Sternberg cells. Annals Oncol, 11, 91-6.
  17. Rosai J. Rosai and Ackerman's Surgical Pathology.9thed. (2004) Elsevier St.Louise (MO): p.1917-3.
  18. Zhou XG, Sandvej K, Li PJ, et al(2001). Epstein-Barr virus (EBV) in Chinese pediatric Hodgkin disease: Hodgkin disease in young children is an EBV-related lymphoma. Cancer, 15, 1621-31.