EPSTEIN-BARR-VIRUS (EBV) AND HODGKINS-DISEASE IN A MULTIETHNIC POPULATION IN MALAYSIA

The Epstein-Barr virus (EBV) has been implicated as a contributing fac tor in the development of Hodgkin's disease. Western cases of Hodgkin' s disease have shown the presence of EBV in Hodgkin and Reed-Sternberg cells in approximately 50%. We studied a total of 100 consecutive cas es of Hodgkin's disease from Malaysia, with the aim to elucidate its a ssociation with EBV in a multi-ethnic Asian population. Of 34 patients (34%) less than 15 years of age (childhood), 25 had classical Hodgkin 's disease (eight nodular sclerosis, 16 mixed cellularity, one lymphoc yte depleted) and nine had lymphocyte predominance Hodgkin's disease. Of the 66 from patients aged 15 years and above, 33 had nodular sclero sis, 24 mixed cellularity, two lymphocyte depleted, one unclassifiable and six lymphocyte predominance Hodgkin's disease. The ethnic distrib ution of classical Hodgkin's disease was: Malay 23, Chinese 32 and Ind ian 30 (Malay:Chinese:Indian = 1:1.4:1.3), and the ethnic distribution in the 15 cases of lymphocyte predominance Hodgkin's disease was: Mal ay four, Chinese 10 and Indian one. Taking into account the ethnic dis tribution of the general population and of hospital admissions, there appears to be a significant predilection of classical Hodgkin's diseas e cases in ethnic Indian compared to non-Indian patients (chi-squared test, 0.025 > P > 0.01). Eighty-one cases were tested for the presence of EBV by in situ hybridization for EBV encoded RNA, and 57 cases by immunostaining for EBV latent membrane protein 1. In the younger age g roup, all except one of the 15 cases (nine mixed cellularity, six nodu lar sclerosis) showed the presence of EBV (93%). In the older age grou p, EBV was detected (52%) in the following proportion: 6/27 nodular sc lerosis, 19/22 mixed cellularity, 1/2 lymphocyte depleted, 1/1 unclass ifiable. None of the 14 cases of lymphocyte predominance Hodgkin's dis ease showed the presence of EBV in the Hodgkin and Reed-Sternberg cell s. The findings suggest a strong association of EBV with Hodgkin's dis ease in Malaysians (41/67, 61%), in particular childhood cases (93%). In adults, the association with EBV is significantly higher in the mix ed cellularity subtype (86%) compared with the nodular sclerosis subty pe (22%).