Bortezomib in Plasmablastic Lymphoma: A Case Report and Review of the Literature

Abstract

Background: Plasmablastic lymphoma (PBL) is an aggressive subtype of non-Hodgkin's lymphoma (NHL). While classically associated with the human immunodeficiency virus (HIV), cases of PBL in immunocompetent patients have been increasingly described. PBL shares common morphological and immunohistochemical features with diffuse large B-cell lymphoma (DLBCL) and multiple myeloma (MM). Due to the rarity of PBL, there is no current consensual standard therapy available. As a result, PBL treatment is mirrored after aggressive NHL regimens. One of the newly emerged therapeutic options for PBL is bortezomib, which is a proteasome inhibitor and a cornerstone in MM therapy. In recently published cases, bortezomib has shown promising results in PBL. Case Report: In this report, we describe a patient with HIV-negative PBL who dramatically responded to bortezomib after failing several other lines of therapy. We also review 4 other, similar cases reported in the literature. Results and Conclusion: We conclude that bortezomib resulted in rapid and dramatical responses regardless of the line of therapy. Although most of these responses were not sustained, bortezomib represents a new therapeutic option for PBL that should be further explored in larger clinical trials.

Stage, age, and EBV status impact outcomes of plasmablastic lymphoma patients: a clinicopathologic analysis of 61 patients

“…This is based primarily on data derived from case reports and small case series. In addition, regimens similar to those used to treat plasma cell myeloma that incorporate bortezomib and consolidation with high-dose chemotherapy followed by autologous stem cell transplant have been suggested [17]. Castillo et al recommended recently frontline EPOCH (+/− bortezomib) with intrathecal prophylaxis during each cycle of EPOCH followed by consolidative high-dose chemotherapy and autologous SCT in first remission, if possible [13].…”

The biology and treatment of plasmablastic lymphoma

“…55 Bortezomib alone and in combination with chemotherapy has been used with limited efficacy in HIV-positive and HIV-negative patients with relapsed PBL. [56][57][58][59][60][61][62] More recently, a case series of 3 previously untreated patients with PBL, 2 of them HIV-positive, has shown efficacy with the combination of bortezomib and dose-adjusted EPOCH. 63 The immunomodulator lenalidomide induced a temporary response in a patient with relapsed PBL.…”

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

“…Several reports have documented activity of the proteasome inhibitor bortezomib in PBL [12,13,14,15,16,17]. The anti-CD30 antibody brentuximab vedotin has also been shown to have activity in 1 report [18].…”