Clinical outcome of elderly patients with Epstein-Barr virus positive diffuse large B-cell lymphoma treated with a combination of rituximab and CHOP chemotherapy

Several studies have suggested the possibility of a prognostic relationship between Epstein-Barr virus (EBV) and diffuse large B-cell lymphoma (DLBCL). The clinical outcome of EBV-associated DLBCL is not clear, especially since the introduction of rituximab. We retrospectively analyzed 222 elderly patients (≥50 years) with DLBCL who received R-CHOP chemotherapy and evaluated the state of EBV-encoded RNA-1 (EBER). Eighteen cases (8.1%) were EBER-positive (+). After a median of six cycles of R-CHOP chemotherapy, the response rate (≥partial response) was 72.2% (13/18) in the EBV (+) patients and 90.2% (184/204) in the EBV (-) DLBCL patients (P=0.021). Four of 18 (22.2%) EBV (+) DLBCL patients received two or fewer cycles of R-CHOP chemotherapy. R-CHOP chemotherapy was also interrupted early more frequently compared with the EBV (-) group (2.5%) (P=0.00). At a median follow-up of 32.8 months, there was no significant difference in the overall survival between the groups (P=0.627). The EBV (+) DLBCL patients with early interruption of R-CHOP chemotherapy showed a trend toward a high EBV-DNA titer (≥1,000 copies/mL) (P=0.091). The results suggest that the EBV (+) tumoral status of elderly DLBCL patients who undergo R-CHOP chemotherapy does not predict their survival but that their EBV status may contribute to the early interruption of R-CHOP chemotherapy.