Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival
| dc.contributor.advisor | Antel, Katherine | |
| dc.contributor.advisor | Verburgh Estelle | |
| dc.contributor.author | Cassim, Sumaiya | |
| dc.date.accessioned | 2022-05-18T12:28:04Z | |
| dc.date.available | 2022-05-18T12:28:04Z | |
| dc.date.issued | 2022 | |
| dc.date.updated | 2022-05-18T12:27:22Z | |
| dc.description.abstract | Introduction: Diffuse large B-cell lymphoma, not otherwise specified (DLBCL NOS) is subdivided according to the cell-of-origin (COO) classification into germinal centre B-cell (GCB) and activated B-cell (ABC) subtypes, each with different molecular profiles and clinical behaviour. This study aims to describe the pattern of the COO subtypes, the proportion of Epstein-Barr virus (EBV) co-infection, and their influence on survival outcomes in a setting of high HIV prevalence. Materials and Methods: This retrospective cohort study included patients diagnosed with de novo DLBCL NOS at our tertiary academic centre in Cape Town, South Africa over a 14-year period. Immunohistochemical stains were performed for COO classification, according to the Hans algorithm. Tumour EBV co-infection was established by EBV-encoded ribonucleic acid in situ hybridisation (EBER-ISH) staining. The effect of the COO subtypes and EBV co-infection on overall survival were described by means of univariate, bivariate and multivariate analyses. Results: A total of 181 patients with DLBCL NOS were included, which comprised 131 HIV-uninfected and 50 HIV-infected patients. There was an equal distribution of GCB and ABC subtypes in the HIV-infected and HIV-uninfected groups. EBV co-infection was detected in 16% of the HIV-infected cases and in 7% of the HIV-uninfected cases (p=0.09). There was no significant difference in the incidence of EBV co-infection between the GCB and ABC subtypes (p=0.67). HIV-infected patients with CD4≥150 cells/mm3 had similar survival to HIV-uninfected patients (p=0.005). Multivariate regression analysis showed that in the HIVinfected group with marked immunosuppression (CD4 <150 cells/mm3), there was significantly poorer overall survival compared to the HIV-uninfected group (HR 2.4, 95% CI 1.3–4.1). There were no statistically significant differences in overall survival by DLBCL COO subtype. Conclusions: There was no difference in the proportion of DLBCL COO subtypes, regardless of HIV status. EBV co-infection was more common in the HIV-infected group, but less than described in the literature. Unexpectedly, there were no significant differences in survival outcomes between the GCB and ABC subtypes. Higher CD4 counts in the HIV-infected group had good survival outcomes, while lower CD4 counts predicted adverse survival outcomes. Further research is needed to explore the genetic mutational landscape of HIVassociated DLBCL. | |
| dc.identifier.apacitation | Cassim, S. (2022). <i>Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival</i>. (). ,Faculty of Health Sciences ,Department of Clinical Laboratory Sciences. Retrieved from http://hdl.handle.net/11427/36418 | en_ZA |
| dc.identifier.chicagocitation | Cassim, Sumaiya. <i>"Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival."</i> ., ,Faculty of Health Sciences ,Department of Clinical Laboratory Sciences, 2022. http://hdl.handle.net/11427/36418 | en_ZA |
| dc.identifier.citation | Cassim, S. 2022. Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival. . ,Faculty of Health Sciences ,Department of Clinical Laboratory Sciences. http://hdl.handle.net/11427/36418 | en_ZA |
| dc.identifier.ris | TY - Master Thesis AU - Cassim, Sumaiya AB - Introduction: Diffuse large B-cell lymphoma, not otherwise specified (DLBCL NOS) is subdivided according to the cell-of-origin (COO) classification into germinal centre B-cell (GCB) and activated B-cell (ABC) subtypes, each with different molecular profiles and clinical behaviour. This study aims to describe the pattern of the COO subtypes, the proportion of Epstein-Barr virus (EBV) co-infection, and their influence on survival outcomes in a setting of high HIV prevalence. Materials and Methods: This retrospective cohort study included patients diagnosed with de novo DLBCL NOS at our tertiary academic centre in Cape Town, South Africa over a 14-year period. Immunohistochemical stains were performed for COO classification, according to the Hans algorithm. Tumour EBV co-infection was established by EBV-encoded ribonucleic acid in situ hybridisation (EBER-ISH) staining. The effect of the COO subtypes and EBV co-infection on overall survival were described by means of univariate, bivariate and multivariate analyses. Results: A total of 181 patients with DLBCL NOS were included, which comprised 131 HIV-uninfected and 50 HIV-infected patients. There was an equal distribution of GCB and ABC subtypes in the HIV-infected and HIV-uninfected groups. EBV co-infection was detected in 16% of the HIV-infected cases and in 7% of the HIV-uninfected cases (p=0.09). There was no significant difference in the incidence of EBV co-infection between the GCB and ABC subtypes (p=0.67). HIV-infected patients with CD4≥150 cells/mm3 had similar survival to HIV-uninfected patients (p=0.005). Multivariate regression analysis showed that in the HIVinfected group with marked immunosuppression (CD4 <150 cells/mm3), there was significantly poorer overall survival compared to the HIV-uninfected group (HR 2.4, 95% CI 1.3–4.1). There were no statistically significant differences in overall survival by DLBCL COO subtype. Conclusions: There was no difference in the proportion of DLBCL COO subtypes, regardless of HIV status. EBV co-infection was more common in the HIV-infected group, but less than described in the literature. Unexpectedly, there were no significant differences in survival outcomes between the GCB and ABC subtypes. Higher CD4 counts in the HIV-infected group had good survival outcomes, while lower CD4 counts predicted adverse survival outcomes. Further research is needed to explore the genetic mutational landscape of HIVassociated DLBCL. DA - 2022 DB - OpenUCT DP - University of Cape Town KW - B-cell lymphoma KW - DLBCL NOS KW - HIV-infected KW - HIV KW - South Africa LK - https://open.uct.ac.za PY - 2022 T1 - Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival TI - Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival UR - http://hdl.handle.net/11427/36418 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/36418 | |
| dc.identifier.vancouvercitation | Cassim S. Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival. []. ,Faculty of Health Sciences ,Department of Clinical Laboratory Sciences, 2022 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/36418 | en_ZA |
| dc.language.rfc3066 | eng | |
| dc.publisher.department | Department of Clinical Laboratory Sciences | |
| dc.publisher.faculty | Faculty of Health Sciences | |
| dc.subject | B-cell lymphoma | |
| dc.subject | DLBCL NOS | |
| dc.subject | HIV-infected | |
| dc.subject | HIV | |
| dc.subject | South Africa | |
| dc.title | Diffuse large B-cell lymphoma in a South African cohort with a high HIV prevalence: an analysis by cell-oforigin, Epstein-Barr virus infection and survival | |
| dc.type | Master Thesis | |
| dc.type.qualificationlevel | Masters | |
| dc.type.qualificationlevel | MMed |