Abstract
Although extranodal NK/T cell lymphoma (ENKTCL) is consistently associated with Epstein-Barr virus (EBV) infection, the manifestation and prognostic value of serum EBV antibodies still remain unknown. One hundred and forty-one patients with ENKTCL were evaluated for serum EBV EA-IgA and VCA-IgA antibodies levels in the past 24 years in our institution. Their correlation with clinicopathological features, plasma EBV DNA load, and patients’ outcomes was analyzed. EBV EA-IgA ≥1:10 and VCA-IgA ≥1:160 were found in 18.4 and 16.3% of patients, respectively. They correlated with adverse ENKTCL profile and inferior overall survival (OS) and progression-free survival (PFS). EA-IgA ≥1:10 was an independent prognostic factor on OS (RR = 2.276, p = 0.008) and associated with lower complete response (CR) rate (34.8 vs 70.6%, p = 0.001) and higher relapse rate in CR patients (62.5 vs 34.7%, p = 0.016). In subgroup analysis, both EA-IgA ≥1:10 and VCA-IgA ≥1:160 significantly correlated with inferior OS and PFS in patients with stage I/II, IPI score 0–1, plasma EBV DNA (+), and CR. Patients with plasma EBV DNA (+) and EA-IgA ≥1:10 (or VCA-IgA ≥1:160) had significantly shorter periods of OS and PFS in comparison with other corresponding groups. Elevated serum EBV EA-IgA and VCA-IgA levels were related to adverse ENKTCL profile and correlated with poor treatment response, early relapse, and poor prognosis in patients with ENKTCL. These findings provide convincing evidence for the use of serum EBV EA-IgA and VCA-IgA antibodies for risk group stratification and prognostic prediction in ENKTCL.
Highlights
Yuhua Huang and Huilan Rao contributed to the work.Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Extranodal NK/T cell lymphoma (ENKTCL) is a distinct subtype of non-Hodgkin lymphoma, which is much more prevalent in Asian and Hispanic population compared with Western population [1, 2]
To our best of knowledge, this is the largest cohort study to explore the manifestation of serum EpsteinBarr virus (EBV) early antigen antibody (EA-IgA) and VCAIgA antibodies in ENKTCL
EBV could be detected by EBER in situ hybridization in tumor cells for all the cases in our series, only 18.4 and 41.1% of ENKTCL patients showed positivity for serum EBV EAIgA and viral capsid antigen IgA (VCA-IgA), respectively
Summary
Extranodal NK/T cell lymphoma (ENKTCL) is a distinct subtype of non-Hodgkin lymphoma, which is much more prevalent in Asian and Hispanic population compared with Western population [1, 2]. It is consistently associated with EpsteinBarr virus (EBV) infection, irrespective of the ethnic origin [3, 4]. EBV serology in patients with nasopharyngeal carcinoma (NPC) has been widely investigated [6,7,8,9,10,11]. Little is known about EBV serology in ENKTCL patients up to date. We previously observed that a part of patients with ENKTCL had
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