Abstract
Introduction: Hodgkin’s disease (HD) accounts for around 6% of all cancers in Lebanese children ≤ 15 years of age. HD shows wide geographic variation in its association with EBV virus. The prognostic significance of Latent EBV infection in HD is still controversial
Purpose: To examine EBV (LMP-1) positivity in pediatric patients treated for HL at the American University of Beirut-Medical Center and the Children’s Cancer Center of Lebanon and its association with age, sex, histologic subtype and treatment outcome.
Methods: The charts of all pediatric patients treated for Hodgkin’s Lymphoma at the American University of Beirut Medical Center between 1980 and 1996, and at the Children’s Cancer Center of Lebanon from 2002 to 2005 were reviewed. Their paraffin blocks were studied for Epstein-Barr virus association by latent membrane protein-1 (LMP-1) immunohistochemistry.
Results: The charts of 34 patients with HD were reviewed. The median age was 7.5 years (range: 2–16 yrs); only 4 patients were above 13 years of age. The M: F ratio was 4.6:1, and the mean follow-up was 4.5 yrs (range 4 months −12y). 6 had stage I, 10 had stage II, 15 had stage III (5 patients IIIA and 10 patients IIIB disease), and 3 had stage IVA disease. 53% had advanced stage disease. 16 patients (47%) had mixed cellularity histologic subtype, 15 patients (44%) had nodular sclerosis subtype, and 3 patients had the lymphocyte predominance subtype. All nine patients who were tested for EBV- IgG were positive. Twenty-three patients were studied for the LMP-1 and 17 (74%) tested positive. These 17 patients make up 89% of the children under 13 years of age who were tested. LMP-1 positivity was associated with young age (≤13 yrs 100%), MC subtype (14 patients; 82.4%) and male sex (16 patients; 94%). Four patients with stage IIIB relapsed. Their treatment consisted of 6–9 cycles of COPP or COPP alternating with ABVD. Three of the relapsed patients were LMP-1 positive and had the MC subtype. Two patients had siblings who had HD; one of them who later relapsed was positive for LMP-1, had the MC subtype, and both he and his brother had immune deficiency and lymphoproliferative disorder.
Conclusions: Our findings show a high prevalance of EBV expression in HD in Lebanese children. These rates are higher than those reported from other neighboring countries and much higher than those of North American and European countries. This may be related to earlier in life infection with EBV. LMP-1 positivity in Lebanese children was associated with younger age, male sex and mixed cellularity subtype. The impact of LMP-1 on treatment outcome remains to be determined.
Author notes
Corresponding author
