Bortezomib- and Lenalidomide-Based Treatment of Refractory Plasmablastic Lymphoma

Abstract

<b><i>Introduction:</i></b> Plasmablastic lymphoma (PBL) is a rare variant of diffuse large B-cell lymphoma for which no optimal treatment has been established and prognosis remains poor. Here, we describe a human immunodeficiency virus-uninfected patient with PBL that was refractory to conventional chemotherapies but was successfully controlled with a bortezomib-based regimen followed by a lenalidomide-based regimen. <b><i>Case Presentation:</i></b> A 64-year-old man suffered from nasal bleeding and occlusion. Whole-body computed tomography results revealed a large lesion occupying his nasal cavity. He was diagnosed with PBL based on a tumor biopsy and was treated with two lines of conventional chemotherapy. A dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) regimen and an ifosfamide, carboplatin, and etoposide (ICE) regimen were ineffective, but the bortezomib-based regimen CyBorD (bortezomib, cyclophosphamide orally, and dexamethasone orally) provided a clinical response. Due to peripheral neuropathy, the patient was then treated with a lenalidomide-based regimen (Ld; lenalidomide and dexamethasone). Although a complete response was not achieved, the Ld regimen was tolerated and was continued with a partial response (PR) for over 2 years. <b><i>Discussion/Conclusion:</i></b> In the present case, PBL that was refractory to conventional chemotherapies responded to the CyBorD regimen and a long-term Ld-based regimen without severe adverse effects. This strategy provided and maintained a PR for over 2 years. Despite not resulting in tumor reduction and only maintaining a PR, continued Ld treatment contributed to long-term survival of the present patient with PBL.

Molecular and functional profiling identifies therapeutically targetable vulnerabilities in plasmablastic lymphoma

“…Our shRNA screen showed that shRNAs targeting IRF4 appeared among the most toxic ones in our plasmablastic cell line model. Correspondingly, treatment with lenalidomide, that has been shown to downregulate IRF4 expression 24 , induced cytotoxicity in PBL-1 cells confirming promising case reports using lenalidomide for the treatment of patients with chemorefractory PBL 45,46 .…”

The Changing Landscape of Lymphoma Associated with HIV Infection

“…These two patients achieved an OS of 18 months and 24 months. Very recently, Ando et al presented a case of a 64-year-old man with HIV-negative PBL refractory to conventional chemotherapy [ 54 ]. This patient responded to CyBorD (bortezomib, cyclophosphamide, dexamethasone), followed by lenalidomide/dexamethasone with a partial remission over 2 years.…”

Case Report: Successful Management of a Refractory Plasmablastic Lymphoma Patient With Tislelizumab and Lenalidomide

“…Without specific care for PBL, intensive regimen like EPOCH only had 47.4–62.0% CR in fit patients ( 14 ). However, some reports of small-scale cases showed anti-PBL activity of non-cytotoxic agents such as bortezomib and lenalidomide ( 15 ). The prognosis of PBL patients is generally poor, with a median overall survival (OS) of 6–19 months ( 4 ).…”