HIV-associated plasmablastic lymphoma in the era of HAART: a single-center experience of 21 patients

Abstract

Objectives: Patients with HIV infection have an increased risk of developing plasmablastic lymphoma (PBL). In this study, we reviewed the clinicopathologic features of PBL in HIV+ patients in the era of HAART from a single health center. Design: Retrospective study. Methods: The morphologic, immunophenotypic, and clinical features were reviewed in these HIV+ patients with PBL and univariate analysis was employed to determine the survival prognosis. Results: During the interval of 1 January 2008 to 30 December 2018, we identified 95 HIV+ patients with aggressive non-Hodgkin B-cell lymphomas. Among these patients, there were 21 (22%) patients with PBL (19 men and two women; median age: 45 years). Seven patients had PBL at their initial HIV diagnosis and 14 developed PBL after a median interval of 7.7 months of HIV diagnosis. Lymph nodes (n = 10), oral cavity/sinonasal mass (n = 6), and rectal masses (n = 5) were the common involved sites, and five of 15 (33%) had bone marrow involvement. Lymphoma cells were immunoreactive for MUM-1/IRF4 (100%), CD138 (90%), CD45 (63%), CD79a (47%), and CD30 (25%). Proliferation rate assessed by Ki67 was at least 90% in 18 of 20 cases. Eighteen patients received chemotherapy including etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (n = 13) and cyclophosphamide, doxorubicin, vincristine, and prednisone (n = 2). With a median follow-up time of 19 months, nine out of 17 patients died. Bone marrow involvement was associated with a poorer overall survival (median: 4.7 months, P = 0.015). Conclusion: PBL is the second most common type of aggressive lymphoma and often presents in lymph nodes of patients with poorly controlled HIV infection. Bone marrow involvement is associated with a poorer outcome.

Primary adrenal plasmablastic lymphoma presenting as lymphomatous meningitis – A diagnostic perplexity

“…PALs are usually diffuse large B cell lymphomas 1,3–6,9,10 . Primary PBL of the adrenal gland in HIV patients is extremely rare, with only a handful of cases having been reported so far.…”

“…9 The use of ART is recommended during chemotherapy, and CNS prophylaxis is considered mandatory due to the fast spread of tumours of this type. 1,2,6,8,9 Median survival is 15 months for HIV-associated PBL. 1 In the current case, we lost the patient to pneumonia.…”

“…CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) and EPOCH (cyclophosphamide, doxorubicin, vincristine, etoposide and prednisone) regimens are used in the treatment of PBL 9 . The use of ART is recommended during chemotherapy, and CNS prophylaxis is considered mandatory due to the fast spread of tumours of this type 1,2,6,8,9 . Median survival is 15 months for HIV‐associated PBL 1 .…”

“…1-3 HIVassociated PBL accounts for approximately 2% of all HIV-related lymphomas, and it has been reported in a wide age range with male predominance. [4][5][6] PBL of the adrenal gland is extremely rare, with only a few cases reported in the literature so far. [7][8][9][10] This case is unique as it presented with features masquerading as primary central nervous system pathology.…”

A Rare Case of HIV-Associated Plasmablastic Lymphoma of Anal Canal

“…The lesion usually shows poor contrast uptake and diffusion restriction, showing homogeneous intermediate T1 signal and an intermediate/high T2 signal [ 8 , 9 ]. Moreover, MRI can also detect bone marrow involvement, seen in one-third of patients with PBL [ 10 ]. Bone marrow involvement upstages the disease and is associated with poor prognosis [ 11 ].…”