Analysis of prognostic factors in patients with EBV positive diffuse large B cell lymphoma of the elderly

Abstract

e19542 Background: EBV positive diffuse large B cell lymphoma of the elderly is a new entity included in the Fourth edition of WHO Classification. It usually affects elderly patients and has a poor survival. It believed to be related to immunesenescence. Aim: The goal of this study was to evaluate clinical characteristics and survival of EBV positive diffuse large B cell lymphoma of the elderly from Peruvian patients. Methods: Between January 2002 and June 2008, eleven patients with EBV positive diffuse large B cell lymphoma of the elderly were included in the analysis. All cases were positive to the presence of EBV encoded RNA (EBER) by CISH and CD20 and/or Pax-5 expression by immunohistochemistry.Clinical data were reviewed retrospectively and patient's biopsies were analyzed for the immunohistochemical expression of BCL6, CD10, CD30 and MUM-1/IRF4 by tissue microarray (TMA) technique.. The survival analysis was performed using the Kaplan - Meier method. Results: The mean age was 72 years old (range 34–85), only two patients had less than 70 years old. B symptoms occurred in 6/11 (54%); ECOG 0–2 ( n=3) and >2 (n=8). Stage: I (n=1), II (n=1), III (n=5) and IV (n=4). The IPI risk score was: low (n=1), low intermediate (n=1), high intermediate (n=5) and high (n=4). Extranodal disease occurred in 6/11 (54%) patients: pleura (n=2), suprarenal gland (n=1), stomach (n=1), cecum (n=1), bone (1), skin (1) and bone marrow (n=1). One was HTLV-1 carrier. Ten cases (83%) were of the Non-GC and 1 case was GC. Three cases were CD30 positivity. Index Prognostic model (age/B symptoms) for this entity was: 0 factors (n=0), 1 factor (n=7) with median survival 9 months; and 2 factors (n=4) with median survival of 1.5 months. Six patients had not received chemotherapy because they had bad status performance and 5 received CHOP-21 regimen. Overall response was 40%. Complete response (n=2), partial response (n=0) and progressive disease (n=3). Median survival was 6.4 months. Only one patient had a long survival (42.5 months). Conclusions: EBV positive diffuse large B cell lymphoma of the elderly was related to high IPI, poor ECOG, frequent extranodal disease, poor response to treatment and very short survival. It is the first report of this entity in a non-Asian population. No significant financial relationships to disclose.