Prognostic impact of pre-treatment and post-treatment plasma Epstein-Barr virus DNA in peripheral T-cell lymphomas.

in Annals of medicine by Chu-Yi Chan, Tung-Liang Lin, Ming-Chung Kuo, Yu-Shin Hung, Hung Chang, Che-Wei Ou, Jin-Hou Wu, Hsuan-Jen Shih, Yi-Jiun Su, Lee-Yung Shih, Yuen-Chin Ong, Wen-Yu Chuang, Hsiao-Wen Kao

TLDR

  • Plasma Epstein-Barr virus (EBV) DNA levels may predict survival outcomes in patients with extranodal NK/T-cell lymphoma, nasal type (NK/TCL), but not in patients with other peripheral T-cell lymphomas.

Abstract

Plasma Epstein-Barr virus (EBV) DNA levels predict the prognosis of extranodal NK/T-cell lymphoma, nasal type (NK/TCL), but its role in other peripheral T-cell lymphomas (PTCL) remains undetermined. This study aimed to determine the prognostic impact of plasma EBV DNA in PTCL patients. We retrospectively enrolled 134 PTCL patients diagnosed between April 2008 and March 2022, with plasma EBV DNA data available at diagnosis in 124 patients and during post-treatment follow-up in 73 patients. International Prognostic Index or prognostic index for T-cell lymphoma scores > 1 was associated with higher median plasma EBV DNA levels in all analyzed patients. Plasma EBV DNA positivity at the time of diagnosis was not associated with treatment response, overall survival (OS), or progression-free survival (PFS) in non-NK/TCL patients. In NK/TCL patients, an EBV DNA level < 3255 copies/mL at diagnosis was significantly associated with higher five-year PFS (64.2% vs. 16.7%,< 0.001) and OS rates (64.4% vs. 20.8%,< 0.001). Plasma EBV DNA positivity at the time of complete remission and during post-treatment follow-up was significantly linked to lower PFS and OS rates in NK/TCL patients. Multivariate analysis revealed that advanced-stage disease, elevated β2-microglobulin, and EBV DNA level ≥ 3255 copies/mL at diagnosis were independent predictors for OS and PFS in NK/TCL patients. Plasma EBV DNA at diagnosis and during follow-up predict survival for NK/TCL patients but not for patients with other PTCL subtypes. Detection and monitoring of plasma EBV DNA levels at diagnosis and post-treatment follow-up for NK/TCL patients is recommended.

Overview

  • The study investigated the prognostic impact of plasma Epstein-Barr virus (EBV) DNA levels in patients with peripheral T-cell lymphomas (PTCL), with a focus on extranodal NK/T-cell lymphoma, nasal type (NK/TCL).
  • A total of 134 PTCL patients were enrolled in the retrospective study, with 124 patients having plasma EBV DNA data at diagnosis and 73 patients having data during post-treatment follow-up.
  • The primary objective of the study was to determine the prognostic value of plasma EBV DNA levels for PTCL patients and whether it could predict treatment response, overall survival, and progression-free survival.

Comparative Analysis & Findings

  • In NK/TCL patients, an EBV DNA level < 3255 copies/mL at diagnosis was significantly associated with higher five-year progression-free survival (PFS) and overall survival (OS) rates, compared to those with higher EBV DNA levels or those who were EBV DNA-negative.
  • In contrast, plasma EBV DNA positivity at diagnosis was not associated with treatment response, OS, or PFS in non-NK/TCL patients.
  • Multivariate analysis revealed that advanced-stage disease, elevated β2-microglobulin, and EBV DNA level ≥ 3255 copies/mL at diagnosis were independent predictors for OS and PFS in NK/TCL patients.

Implications and Future Directions

  • The findings suggest that monitoring plasma EBV DNA levels at diagnosis and post-treatment follow-up may be useful for predicting survival outcomes in NK/TCL patients.
  • However, further studies are needed to confirm the role of plasma EBV DNA levels in predicting treatment response and survival outcomes in patients with other PTCL subtypes.
  • The study's findings may also have implications for the development of novel therapeutic strategies and biomarkers for NK/TCL patients.
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