Journal: International journal of cancer
This publication is a systematic review and meta-analysis assessing the proportion of lymphomas attributable to Epstein-Barr virus (EBV), using EBV-encoded RNA in situ hybridization to define EBV positivity.
Design and scope:
- Timeframe: Studies published from 1990 to 2024.
- Data: 307 studies including more than 21,140 lymphoma cases.
- Stratification: By lymphoma subtype, HIV status, and geographical region.
Key findings (HIV-negative individuals):
- Diffuse large B-cell lymphoma (DLBCL): EBV positivity 10.8% (95% CI 8.6–13.5).
- Burkitt lymphoma (BL): 45.8% (35.2–56.8).
- Hodgkin lymphoma: 53.0% (46.9–58.9).
- Plasmablastic lymphoma (PBL): 52.5% (29.6–74.4).
- Extranodal NK/T-cell lymphoma (ENKTL): 92.4% (83.3–96.7).
- Follicular lymphoma: 5.1% (2.7–9.4).
Key findings (people living with HIV):
- DLBCL: 43.6% EBV-positive (31.5–56.5).
- BL: 43.3% (27.9–60.2).
- PBL: 79.4% (65.6–88.6).
- Overall: Across these subtypes, EBV prevalence is substantially higher than in HIV-negative patients.
Geographical variation:
- Burkitt lymphoma: Shows clear regional heterogeneity in EBV positivity.
- East Africa: Near-universal EBV positivity is observed in Burkitt lymphoma from this region.
- Other subtypes: Did not show such pronounced regional variation based on the abstract.
Implications:
- EBV contribution: EBV contributes substantially to the burden of several lymphoma subtypes, particularly ENKTL, Hodgkin lymphoma, PBL, and BL.
- HIV context: The contribution is especially marked among people living with HIV.
- Use of pooled estimates: These pooled prevalence estimates can support more accurate quantification of EBV-related cancer burden and inform:
- EBV vaccine development and prioritization,
- Early diagnosis strategies in high-risk populations (e.g., PLHIV, endemic regions),
- Consideration of EBV-targeted therapies or immune-based approaches in EBV-positive lymphomas.