Abstract
e18538 Background: EBV+ diffuse large B-cell lymphoma (DLBCL) of the elderly is a new entity included in the WHO Classification. It usually affects elderly patients and has a poor survival, and it is believed to be related to immunosenescence. The goal of this study was to evaluate clinical characteristics and survival of EBV+ DLBCL of the elderly from our institution. Methods: Between January 2002 and June 2008, 33 patients with EBV+ DLBCL of the elderly were identified and included in the analysis. All cases were positive for the presence of EBV-encoded RNA (EBER) by in situ hybridization and CD20 and/or Pax-5 expression by immunohistochemistry (IHC). Clinical data were reviewed retrospectively and patients’ biopsies were analyzed for the expression of BCL6, CD10, CD30 and MUM-1/IRF4. The survival analysis was performed using the Kaplan-Meier method. Results: The median age was 70 years (range 25-85 years); four patients were <50 years of age. B symptoms occurred in 14 (46%), ECOG >2 was seen in 19 (61%), and advanced stage in 16 patients (57%). The IPI score was high intermediate and high in 19 patients (61%). Extranodal disease occurred in 15 patients (48%); GI tract (n=6), oral cavity (n=3), soft tissue (n=2), CNS (n=2), lung (n=2), adrenal gland (n=1), peritoneum (n=1), and bone marrow (n=1). Interestingly, three patients (9%) were HTLV-1 carriers. By IHC, 21 patients (72%) had a non-germinal center (NGC) profile and nine cases (27%) were CD30+. Eight patients did not receive chemotherapy because of a poor performance status. From the 23 patients who received chemotherapy, 9 received R-chemotherapy with an ORR of 67% (5 complete responses and 1 partial response), and 14 received chemotherapy with an ORR of 29% (4 complete responses). Median overall survival (OS) for the whole group was 6 months. The median OS for patients who did not receive therapy was 1.5 months, 12 months for patients who received chemotherapy and 20 months for R-chemotherapy (p=0.001). Conclusions: EBV+ DLBCL of the elderly was associated with high IPI scores, poor performance status, frequent extranodal involvement, NGC profile, poor response to treatment and short survival rate. The role of rituximab-containing regimens in EBV+ DLBCL of the elderly needs further evaluation.
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