Changing patterns in the frequency of Hodgkin lymphoma subtypes and Epstein–Barr virus association in Taiwan

Abstract

Epstein-Barr virus (EBV) infection is a risk factor for Hodgkin lymphoma (HL).To test whether the frequency of HL subtypes and their association with EBV has shifted with rising socioeconomic status in Taiwan, we compared the pathological features and EBV status, detected by in situ hybridization, of HL diagnosed between 1996 and 2007 (99 cases) and 1982 and 1995 (74 cases). The male-tofemale ratio was 121:52 (2.3:1) and the mean age at presentation was 41.5 years. The overall EBV positivity rate was 50% (86/173 cases). Comparing the distribution of HL cases diagnosed at two different time periods, we found an increased frequency of the nodular sclerosis (NS) subtype (53 vs 68%, P = 0.045), a decreased frequency of the mixed cellularity subtype (35 vs 13%, P < 0.001), a reduced male-to-female ratio (2.9:1 compared to 1.4:1) and mean age (42.4 vs 36.6 years) in the NS subtype, and a significant decrease in EBV positivity rates among the NS and lymphocyte-depletion subtypes (61 vs 39%, P = 0.03). These data indicate shifts in the frequency of histological subtype and EBV association for HL in Taiwan (1) Previous studies have demonstrated that acute EBV infection (or infectious mononucleosis) is a risk factor for Hodgkin lymphoma (HL), (2,3) and its infectious manifestations, especially age at infection, are affected by socioeconomic status. (4,5) Among the five subtypes of HL, nodular lymphocyte predominance (NLP), nodular sclerosis (NS), mixed cellularity (MC), lymphocyte-rich classical (LRC), and lymphocyte depletion (LD), the MC subtype is most frequently associated with EBV worldwide, ranging from 72 to 86%, whereas the NLP subtype is almost always EBV negative in Western countries.(6-8) However, we and others have previously found that EBV is associated with all histological subtypes of HL in Vietnamese and southern American children, especially the NLP subtype, which showed a 100% positivity rate. (6,9,10) The differences in EBV association between HL in developed and developing countries and with different histological subtypes may be reconciled by the 'two-disease hypothesis', which proposes that the HL seen in the younger group is infectious in nature whereas that in older persons has causes similar to other types of lymphomas. (11,12) Epidemiological studies have revealed three patterns of HL distribution. Pattern 1, seen in developing countries and in patients of low socioeconomic status, shows an early childhood peak with tumors that are predominantly MC subtype and EBV positive. Pattern 3, seen in developed countries and in patients of high socioeconomic status, shows a peak incidence in the third decade with tumors that are mainly NS subtype and EBV negative. Pattern 2, seen in countries with transitional economies, has an early childhood peak and a second decade peak with an equal frequency of the MC and NS subtypes. (2,13,14) It is therefore intriguing to observe whether there exists a change in the frequency of HL subtypes and EBV association with time in countries like Taiwan, where socioeconomi...

Distribution of lymphoid neoplasms in the Republic of Korea: Analysis of 5318 cases according to the World Health Organization classification

“…The low proportion of HL in our study (4.1% of total lymphoid neoplasms) was also in good agreement with previous results from Asian countries [1,2,6,9,[13][14][15][16][17][18][19][20][21]23,[25][26][27][28][29][30][31][32][33][34][35][36]38,45,46]. Although the proportion of overall HL was low, subtype distribution showed similar pattern to previous studies from various regions, with nodular sclerosis and mixed cellularity being the common subtypes (Supplementary Table III).…”

Epstein–Barr virus and Hodgkin’s lymphoma in Cairo, Egypt

“…-Middle East (including Tunisia) [4][5][6][7][8][9][10][11][12]: between 28% of cases in a series from Jordan [12] and 70% of cases from Tunisia [4] were EBV-positive with HL; for Egypt [8], 50% were positive and 67% were of the NS type, which is similar to our findings -East Africa [13][14][15][16]: between 44% and 92% of cases were positive in Kenya -Central and South America [17][18][19][20][21][22][23]: between 31% of cases in Argentina [23] and 84% of cases in Peru [17] were positive -Asia [14,[24][25][26][27][28][29][30]: between 39% of cases in China [30] and 82% of cases in India [24] were positive, and the percentage of positive cases in most other countries was high (50% to 69%). For each country, the first column shows the number (n°) of cases studied whereas the other columns show the percentages of positive cases.…”

Malignant lymphomas (ML) and HIV infection in Tanzania

“…[14,20] Unexpectedly however, HD cases in our current study did not show the usual clear bimodal age pattern although the mean age of 26 years was concordant with that reported in a previous Ugandan study. [34] Apparently, the mean age in our series and the Ugandan study indicate that East African HD presents at a considerably younger age than that reported in USA (≈33 years) and Taiwan (41.5 years) [13,34,35] The reasons for the differences are not clear although these may include age-related oncogenic factors, geographical and other environmental factors as well as the influence of HIV infection in sub-Saharan Africa, considering the above-stated proportion of HIV infected HD patients at MNH in our current study. [24] Reports show that childhood HD occurs at a younger age in various countries with limited resources than in western countries.…”