Epstein–Barr virus-associated lymphoma: current understanding and treatment strategies

Abstract Epstein–Barr virus (EBV) infection is well-known for its high prevalence rate, association with several diseases including cancer and autoimmune conditions, and a wide variety of symptoms and prognosis. When acquired at a young age, primary infections are often asymptomatic; however, in adolescence and young adulthood, symptomatic infections develop, such as in infectious mononucleosis. A special feature of EBV infection is its ability to establish a latent infection in B cells which can lead to long-term infection. Subsequent cellular transformation and viral protein expression can result to EBV-mediated carcinogenesis. Latent proteins expressed by EBV play a role in the pathogenesis of EBV infection and carcinogenesis. These proteins are responsible for a diverse range of functions including cell transformation, cell reprogramming, immune evasion, immune suppression, angiogenesis, cell cycle regulation, and B-cell receptor mimicry. EBV infection is associated with diffuse large B-cell lymphoma, Hodgkin lymphoma, NK/T cell lymphoma, Burkitt lymphoma, post-transplant lymphoproliferative disorders, and primary CNS lymphoma. The clinical presentation varies depending on the specific disease and EBV status, with EBV-positive lymphomas generally associated with poorer prognosis than EBV-negative cases. This review aimed to examine the current understanding of the pathogenesis of EBV-associated lymphoma and to evaluate emerging and accepted therapeutic strategies.