Epstein-Barr virus infection, drug resistance and prognosis in Korean T- and NK-cell lymphomas

Pathol Int. 2001 May;51(5):355-63. doi: 10.1046/j.1440-1827.2001.01214.x.

Abstract

T-cell lymphomas are a biologically heterogeneous group of diseases with varying clinical presentations and outcomes. We tried to understand the effect of Epstein-Barr virus (EBV) on lymphogenesis, prognostic factors and drug resistance of T-cell lymphomas, and to establish their relationship with international prognostic factors. Formalin-fixed paraffin-embedded tissue sections from 35 patients (12 women and 23 men) with T-cell lymphomas were examined to detect the presence of EBV using RNA in situ hybridization for EBV-encoded small nuclear RNA (EBER) 1/2 and immunohistochemical stain for latent membrane protein (LMP)-1. We also tried to establish the expression of p53 and P-glycoprotein (P-gp) using immunohistochemistry. The distribution according to the subgroup was: two T-lymphoblastic lymphomas, 13 NK/T-cell lymphomas, one angioimmunoblastic T-cell lymphoma, 17 peripheral T-cell lymphomas, unspecified, and two anaplastic large cell lymphomas. The EBER was detected in 15 of 35 T-cell lymphomas (42.9%) and among these it was detected in five of 17 nodal lymphomas (29.4%) and 10 of 18 extranodal lymphomas (55.6%). There was close correlation between EBER positivity and NK/T-cell lymphoma (P = 0.032). Expression of LMP was found in a proportion of tumor cells in seven of the 15 EBER-positive cases (46.7%). There was no correlation between EBER expression and complete response (CR rate), but coexpression of EBER and p53 was associated with treatment failure (P = 0.047). The 18 patients (51.4%) with p53 expression had significantly poorer outcomes compared with the 17 patients without p53 expression (CR rate, P < 0.0005; overall survival, P = 0.0102). Twenty of 35 patients (57.1%) were positive for P-gp expression. P-gp expression was significantly associated with treatment failure (P = 0.001) and overall survival (P = 0.0089). Seventeen of 35 patients (48.6%) treated with systemic chemotherapy or radiation therapy achieved a CR after initial treatment. When the prognostic factors were grouped using the international prognostic index, the CR rate was 58.8% for the low risk group, 50.0% for the low-intermediate risk group, 14.3% for the high-intermediate risk group, and 0% for the high risk group. In conclusion, high incidence of EBV was detected among Korean patients with T-cell lymphomas. Our study supports the prediction that patients who express p53 and P-gp have a poorer prognosis than those who do not and this should be considered when treatment strategies for individual patients are selected.

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily B, Member 1 / analysis
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Drug Resistance, Neoplasm
  • Epstein-Barr Virus Infections / complications*
  • Epstein-Barr Virus Infections / pathology
  • Female
  • Herpesvirus 4, Human / genetics
  • Herpesvirus 4, Human / isolation & purification
  • Humans
  • In Situ Hybridization
  • Infant
  • Killer Cells, Natural / pathology
  • Killer Cells, Natural / virology*
  • Lymphoma, T-Cell / chemistry
  • Lymphoma, T-Cell / mortality
  • Lymphoma, T-Cell / pathology
  • Lymphoma, T-Cell / virology*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • RNA, Viral / analysis
  • Survival Analysis
  • Survival Rate
  • Tumor Suppressor Protein p53 / analysis

Substances

  • ATP Binding Cassette Transporter, Subfamily B, Member 1
  • Epstein-Barr virus encoded RNA 1
  • Epstein-Barr virus encoded RNA 2
  • RNA, Viral
  • Tumor Suppressor Protein p53