全血 EBV DNA 状态在 T/NK 细胞淋巴瘤相关噬血细胞性淋巴组织细胞增生症中的意义：一项单中心回顾性分析

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory condition often triggered by malignancies, especially T/NK-cell lymphoma-associated HLH (T/NK-LAHLH). Epstein-Barr virus (EBV) infection is strongly linked to T/NK-LAHLH and worsens prognosis. However, the prognostic value of whole-blood EBV DNA levels in T/NK-LAHLH remains unclear, necessitating further investigation to improve risk assessment and treatment strategies.

To investigate the clinical characteristics and prognostic significance of whole-blood EBV DNA status in patients with T/NK-LAHLH. DESIGN: A single-center, retrospective study was conducted, including 85 patients diagnosed with T/NK-LAHLH between January 2017 and August 2022. Patients were categorized based on EBV DNA status, and clinical outcomes were compared.

EBV DNA levels were quantified using polymerase chain reaction (PCR) assays. Kaplan-Meier survival and Cox regression models to assess overall survival (OS) and identify independent prognostic factors.

A total of 85 T/NK-LAHLH patients were included, with a median age of 52 years (range: 18-81 years) and 60% male. The OS rates at 1, 3, 6, and 12 months were 66.6%, 49.8%, 33.8%, and 28.4%, respectively. Among these patients, 67 (78.8%) were EBV DNA-positive, while 18 (21.2%) were EBV DNA negative. EBV DNA-positive patients exhibited significantly lower platelet and globulin levels, higher IL-10 levels, and prolonged activated partial thromboplastin time compared to EBV DNA-negative patients ( p < 0.05). The 6-month OS rate was significantly lower in EBV DNA-positive patients compared to EBV DNA-negative patients (22.5% vs 75.1%, p < 0.001). Multivariate analysis identified EBV DNA positivity as an independent risk factor for shorter 6-month OS (hazard ratio (HR): 4.715; 95% CI: 1.662-13.377; p = 0.004). Among the four patients who underwent allogeneic hematopoietic stem cell transplantation, all achieved complete remission and remained alive at the last follow-up.

Whole-blood EBV DNA positivity is a significant prognostic factor for poor outcomes in T/NK-LAHLH patients. These findings highlight the need for incorporating EBV DNA monitoring into clinical management and further research to refine therapeutic strategies. Epstein-Barr virus in blood signal poor survival in a rare, severe immune condition Hemophagocytic lymphohistiocytosis (HLH) is a rare but severe illness caused by an overactive immune system. It can occur in people with certain cancers, especially T/NK-cell lymphoma. When this condition is linked to infection with the Epstein-Barr virus (EBV), the outcomes are often worse. This study examined how EBV levels in the blood relate to survival in people with HLH linked to T/NK-cell lymphoma. We analyzed data from 85 patients treated between 2017 and 2022. Most patients (78.8%) had EBV detected in their blood. These patients were sicker overall, with lower platelet levels, longer blood clotting times, and higher inflammation markers. Survival was significantly worse for patients with EBV in their blood. After six months, only 23% of these patients were alive, compared to 75% of patients without EBV. Our findings showed that having EBV in the blood was an independent factor linked to poor survival, along with being older than 50, high inflammation levels, and blood clotting problems. However, patients who received a bone marrow transplant did better, with all such patients in this study surviving. This research shows that testing for EBV levels in the blood can help doctors predict outcomes for patients with HLH and T/NK-cell lymphoma. Monitoring EBV levels could guide treatments and improve care for these high-risk patients. Bone marrow transplant may offer hope for long-term survival in some cases.