Molecular Detection of Epstein-Barr Virus (EBV) in Patients with Non-Hodgkin Lymphoma Attending the Haematology Units of Tertiary Care Hospitals in Yangon

Moh Moh Htun, Tun Lwin Nyein, Aye Aye Gyi, Sein Win, Mya Ohnmar, Theingi Thet Paing Htun, Hnin Nu Htwe, Khin Kant Kaw Oo & Khine Moe Aung

Myanmar Health Sciences Research Journal

Non-Hodgkin Lymphoma (NHL) is one of the lymphoproliferative disorders and it is common haematological malignancy in Myanmar.
A cross-sectional descriptive study involved 83 cases of Non-Hodgkin Lymphoma (NHL) attending the Haematological Units, Yangon General Hospital and North Okkalapa General and Teaching Hospital, Yangon from August 07 to September 08. The mean age of NHL cases was 50.5±7.07 years and 47(57%) cases were male and 36(43%) cases were female. Out of 83 cases of NHL, 34(4%) cases were type I indolent chronic lymphoma, 48(58%) cases were type II aggressive lymphoma and (%) case in type III highly aggressive lymphoma. After extraction of DNA, EBNA  was only detected in 6/83(9.3%) cases of NHL at 6 base pair by using polymerase chain reaction (PCR). EBNA (300 base pair) was not found in all cases by using specific EBNA primer. EBV serotype  was found in 44% in Histological Type I NHL, 50% in Type II NHL and 6% in Type III NHL, respectively. Type I NHL was mostly in follicular lymphoma, small lymphocytic and extranodal histology types and Type II NHL was mainly in diffuse large B cell lymphoma and anaplastic large cell and Type III was mostly in plasmablastic B cell lymphoma. EBV-DNA was detected in low grade and intermediate grade of NHL in this study. 

Global cancer rates could further increase by 50% to 15 million new cases in the year 2020, according to the World Cancer Report from the World Health Organization in 2003.¹ Non-communicable diseases (NCDs) are the leading causes of death in the world and nearly 80% of NCD deaths occur in low-and middle-income countries. It comprises of mainly cardiovascular diseases, cancers, diabetes and chronic lung diseases.² Lymphoid malignancy varies epidemiology and aetiology in different areas around the world. In Asians, there are higher rates of aggressive non-Hodgkin lymphoma (NHL), T-cell lymphomas and extra-nodal disease. Hodgkin Lymphoma (HL) is relatively very uncommon in Asian countries.³

Sampling and data collection

A cross-sectional descriptive study involved 83 cases (47 cases (57%) were male and 36 cases (43%) were female) of Non-Hodgkin Lymphoma (NHL) attending the Clinical Haematology Department Yangon General Hospital and North Okkalapa General and Teaching Hospital, Yangon during August 2017 and September 2018. Informed consent was taken from histologically confirmed NHL cases who visited outpatient depart-ments and some were attending these two hospitals. The three millilitres (ml) of whole blood samples from all subjects were collected with ethylenediamine tetraacetic acid (EDTA) contained tubes under aseptic condition. All clinical data including fever, site of lymph node enlargement, cycles of chemotherapy and laboratory data (histology report) were collected by using proforma.

The EB virus is one of the Herpesviridae families that maintain a life-long persistent infection in over 90% of healthy adult population with low copy number in memory B cells.¹⁴ EBV Nuclear Antigen1 (EBV- NA1) is the only viral protein expressed in all forms of latent stage in EBV-related cancers. EBV genotype 1 is most prevalent in all types of lymphoma in Pakistan study.¹⁵ Characteristic of EBV is mainly in B lymphocytes by tropism activity and it may transform to B-cell lymphoma under certain condition. The most common form of lympho-proliferative disorders related to EBV are B-cell lymphomas; Hodgkin lymphoma (HL), NHL including Burkitt lymphoma and DLBCL.¹⁶

The authors would like to express their sincere thanks to the Director-General, Deputy Director-Generals and Board of Directors from the Department of Medical Research for their encouragement to support research fund of DMR Grant and allowing us to conduct this study. We would also thank medical doctors and nurses of Haematology Units of Yangon General Hospital (YGH) and North Okkalapa General and Teaching Hospital (NOGTH), Yangon. We extend our deepest thanks to participants who took part in this study. 

Competing interests

The authors declare that they have no competing interests.

1. World Health Organization. The Major Findings of the World Cancer Report. [Internet]. 2003. Available from: http:// www.who.int/mediacenter/news/releases/2003/ pr27/en/ Accessed date on 22^nd Oct 2009

2. World Health Organization. Global Status Report on Communicable Diseases 2010. [Internet]. 2011. Available from: http:// www.who.int/nmh/publications/ncd_report2010/en/ Accessed date on 2^nd August 2017

3.       Zahra M. Epidemiology Insights. In: Epidemiology of Lymphoid Malignancy in Asia. Chapter 16. 2012; Pp 325-354. Internet] Available from: www. intecopen. com Accessed date on 23^rd February 2017