THE ROLE OF EPSTEIN-BARR VIRUS IN HAEMATOLOGICAL MALIGNANCIES

Abstract

The majority of adults worldwide are infected with the Epstein-Barr virus (EBV). It was the first human virus to be linked to cancers and is now considered a causative factor in the development of a broad group of B-cell, T-cell and NK-cell neoplasms. This narrative review summarises the role of EBV in haematological malignancies. A structured search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for English-language publications available up to October 2026, supplemented by current guidance from international health authorities. It covers pathogenesis, the clinical features and prognostic meaning of EBV in eight entities, diagnosis and prevention. EBV acts through latent proteins such as LMP1, LMP2A and EBNA2, through viral microRNAs, and through changes in host signalling, antigen presentation, immune checkpoints and the tumour microenvironment. Deletions and variants of the viral genome add a further layer. EBV is found in nearly all endemic Burkitt lymphoma, extranodal NK/T cell lymphoma, in a minority of sporadic Burkitt lymphoma and diffuse large B-cell lymphoma. Prognostic meaning differs between entities. The presence of an EBV infection was associated with a poorer prognosis in diffuse large B-cell lymphoma, NK/T cell lymphoma and, in a meta-analysis, Hodgkin lymphoma. In plasmablastic lymphoma the largest cohort found lower survival rate in EBV-negative disease. Epstein-Barr virus-encoded RNA (EBER) in situ hybridisation remains the diagnostic standard. Plasma EBV DNA adds prognostic and monitoring value, but assays and cut-offs are not standardised. Rituximab prophylaxis and DNA surveillance lower the risk of post-transplant lymphoproliferative disorder in selected groups. Due to the high complexity of the EBV virus, no vaccine has yet been developed against it.