A Case of Plasmablastic Lymphoma Achieving Complete Response and Durable Remission after Lenalidomide-Based Therapy

Abstract

Background: Plasmablastic lymphoma (PBL) is an uncommon variant of diffuse large B-cell lymphoma that is characterized by its plasmacytoid features, aggressive tendencies, and frequent association with human immunodeficiency virus (HIV) infection or other immunocompromised states. Multi-agent, intensive chemotherapy regimens are recommended as first-line treatment by the National Comprehensive Cancer Network. However, the toxicity of these regimens is high and prognosis remains poor. Case Report: We report a patient with HIV-negative PBL who achieved complete response and durable remission using a lenalidomide-based chemotherapy regimen as first-line therapy. Conclusion: Cyclophosphamide, lenalidomide, dexamethasone (CRD) may provide an alternative initial therapeutic option for patients with PBL who cannot tolerate the intensive chemotherapy regimens currently recommended.

A patient with plasmablastic lymphoma achieving long-term complete remission after thalidomide-dexamethasone induction and double autologous stem cell transplantation: a case report

“…For this reason, the use of antimyeloma agents – like bortezomib, thalidomide or lenalidomide - may have a sound rationale, although the experience with these agents is rather limited. More specifically, they have been predominantly combined with more standard lymphoma-directed regimens, such as CHOP or EPOCH [ 8 – 15 ], rather than applied in MM-like treatment algorithms, also considering at least one ASCT as part of the frontline approach. Case reports accounting for the use of either bortezomib or lenalidomide, applied as single agents or within combinations in both untreated and relapsing PBL patients, have been published in the last few years, sometimes with considerable benefit (Table 1 ).…”

A Rare Presentation of HIV-Negative Plasmablastic Lymphoma: A Diagnostic Dilemma

“…This patient was HIV-negative, and presence or absence of EBV could not be firmly established. While some criteria for multiple myeloma were present including anemia, renal insufficiency, and elevated free light-chain ratio, the patient lacked the presence of lytic lesions and hypercalcemia that would have favored a diagnosis of multiple myeloma [8]. Ultimately, the diagnosis of PBL was favored over PCM due to the aggressive presentation associated with diffuse lymphadenopathy, elevated LDH, and hyperuricemia.…”

“…A recently published case report of PBL involving the right parotid gland in a HIV-negative patient showed continuous complete remission at 12 months using bortezomib plus lenalidomide upon relapse after CHOP [14]. Another case report of HIV-negative PBL utilizing a lenalidomide-based regimen with complete remission at 24 months suggests its usage as an alternative therapy for patients unable to tolerate intensive chemotherapy [8].…”

Plasmablastic lymphoma masquerading solitary plasmacytoma in an immunocompetent patient

“…Lenalidomide based-chemotherapy has been shown to achieve good response in PBL. 14–16 However, lenalidomide alone was seldom used in PBL. Interestingly, there are few case reports that has described dramatic response to single-agent lenalidomide in PBL.…”