The effect of epstein-barr virus expression on the clinical outcome of patients with nodular sclerosis hodgkin's disease

الملخص EN

Purpose : the aim of this work is to evaluate the effect of the immunological change associated with Epstein Barr Virus (EBV) on the clinical outcome of patients with nodular sclerosing Hodgkin’s Disease.

Material And Methods : Forty-eight patients with the diagnosis of Hodgkin disease were studied retrospectively.

The median age was 17 years (range 7-77), 31 males and 17 females, 5 patients had stage I disease, 17 stage II, 13 stage III and 13 stage IV.

B-symptoms were present in 24 patients, 27 patients were treated with chemotherapy alone, 2 patients with radiotherapy alone, 16 patients had combined modality treatment (chemotherapy and radiotherapy) and 3 patients received no treatment.

Results : Half of the patients had tumors positive for EBV, the mean helper to suppressor T lymphocytes (CD4 / CD8) ratio was 5.27 (range 0.27-40), the mean T to B lymphocytes (CD3 / CD19) ratio was 6.6 (range 0.6-32.5).

The mean CD19 / CD20 ratio was 23 (range 2-58).

Excluding the 3 patients who received no treatment, the 5 years overall survival was 82.7 %, and the relapse free survival was 49 %.

On univariate analysis patients who had a high CD4 / CD8 ratio (≥ 1.5) had significantly better overall survival (OS) than those with lower CD4 / CD8 ratio (88 % vs.

58 %, p = 0.03).

Patients who had a high CD4 / CD8 ratio and were EBV negative had a significantly better OS compared to patients with low CD4 / CD8 ratio and who were EBV positive (border-line immunity).

Age was a determinant prognostic factor for relapse free survival (RFS), younger patients (40 years) did significantly better compared to older patients, (54% vs.

17 %, p = 0.007), the effect of age on RFS was consistently seen on multivariate analysis with a p value of 0.03.