To evaluate the associations of plasma EBV-DNA and tumor EBV status with clinical outcomes in patients with AIDS-related non-Hodgkin lymphoma (ARL). We retrospectively analyzed ARL patients diagnosed at Shanghai Public Health Clinical Center between 2013 and 2021. Tumor EBV status was determined by EBV-encoded RNA (EBER) in situ hybridization, and plasma EBV-DNA was quantified using real-time PCR. Survival outcomes were evaluated using Kaplan–Meier analysis and Cox regression. Longitudinal EBV-DNA patterns during chemotherapy were classified into four groups: persistently negative, persistently positive, clearance, and conversion. Among 183 ARL patients, 99 underwent tumor EBER testing with 45.5% (45/99) positivity. Survival analysis was performed in 85 ARL patients who received treatment. The 2-year overall survival (OS) did not differ by EBER status (positive: 63.2% vs. negative: 52.5%; HR 0.86, 95% CI 0.41–1.80; p = 0.695). Baseline plasma EBV-DNA was quantified in 52 patients, with 47 (90.4%) undergoing ≥ 4 tests during chemotherapy cycles. Baseline plasma EBV-DNA levels were not predictive of prognosis. However, detectable EBV-DNA during chemotherapy was associated with significantly inferior OS (p = 0.048) and remained an independent prognostic factor after adjustment. Longitudinal analysis showed no statistically significant survival differences among four EBV-DNA patterns (p = 0.074), but patients with persistently positive or conversion patterns exhibited poorer outcomes, while persistently negative or clearance patterns were associated with more favorable prognosis. Pairwise analysis confirmed significantly better survival in persistently negative compared with persistently positive patients (p = 0.016). Dynamic monitoring of plasma EBV-DNA during chemotherapy provides important prognostic information in ARL. Persistent or newly detectable EBV-DNA identifies patients at higher risk of poor outcomes, supporting the clinical utility of longitudinal EBV-DNA assessment for risk stratification and treatment guidance.
Wang et al. (Fri,) studied this question.