Characteristics and prognosis of Epstein Barr virus-positive diffuse large B-cell lymphoma: a retrospective, single-center study

Objective To analyze the clinical characteristics and prognosis of Epstein–Barr virus-positive diffuse large B-cell lymphoma (EBV+DLBCL) in a Chinese cohort.Methods Fifty-seven EBV+DLBCL patients (diagnosed between 2013 and 2020) and 228 EBV-negative DLBCL (EBV-DLBCL) controls were included. Differences were compared and prognostic factors were identified using univariate and multivariate analysis.Results EBV+DLBCL patients (median age, 56 years; 38 men [66.7%]) predominantly had non-GCB origin (70.2%). Compared with EBV-DLBCL, EBV+DLBCL patients more frequently presented with B symptoms, hypoalbuminemia, anemia, >1 extranodal site involvement, and elevated LDH andβ2-microglobulin (all P < 0.05). The common extranodal sites were the digestive tract (stomach), nasopharynx, bone marrow, and bone. CD30 positivity was higher in EBV+DLBCL patients (42.1% vs. controls, P < 0.001). After R-CHOP-like therapy, EBV+DLBCL patients achieved complete and overall response rates of 55.5% (30/54) and 83.3% (45/54), respectively. With a median follow-up period of 28 months, the relapse rate was 22.2% (10/45). The response and relapse rates were similar between groups. Multivariate analysis identified elevatedβ2-microglobulin and bone marrow invasion as independent risk factors for worse progression-free survival (PFS), and elevatedβ2-microglobulin plus decreased hemoglobin for worse overall survival (OS) in EBV+DLBCL.Conclusion EBV+ DLBCL in this Chinese cohort was primarily non-GCB. Elevatedβ2-microglobulin and bone marrow invasion independently predicted inferior PFS, while elevatedβ2-microglobulin and anemia predicted inferior OS.