Human immunodeficiency virus‐associated plasmablastic lymphoma

Abstract

BACKGROUND: Plasmablastic lymphoma (PBL) is a rare and aggressive B‐cell lymphoma strongly associated with human immunodeficiency virus (HIV) infection. The authors conducted a multi‐institutional, retrospective study to describe characteristics and determine prognostic factors in HIV‐associated PBL. METHODS: For this study, the investigators included consecutive, HIV‐positive patients diagnosed between the years 2000 and 2010 whose tumors had a plasmablastic morphology, were cluster of differentiation 20 (CD20)‐negative, and expressed markers of plasmacytic differentiation. RESULTS: Fifty patients from 13 institutions were evaluated. The median age was 43 years, and there was a male predominance. The median count of cells that were positive for CD4 (a glycoprotein expressed on the surface of T‐helper cells, monocytes, macrophages, and dendritic cells) was 206 cells/mm3. At presentation, 90% of patients had extranodal involvement, 69% presented with advanced stage disease, and 27% had oral involvement. Rearrangements of v‐myc myelocytomatosis viral oncogene homolog (MYC) were detected in 41% of the tested patients. Eighty‐five percent of patients received chemotherapy, with 63% receiving cyclophosphamide, doxorubicin, vincristine, and prednisone and 37% receiving more intensive regimens. The complete response (CR) rate was 66%. The median overall survival (OS) was 11 months regardless of the intensity of chemotherapy. In the survival analysis, an Eastern Cooperative Oncology Group performance status ≥2, advanced stage, and MYC rearrangements were associated significantly with a worse outcome, whereas attaining a CR with chemotherapy was associated with a better outcome. CONCLUSIONS: The prognosis of PBL in HIV‐infected individuals remains poor in the highly active antiretroviral therapy era. Intensive chemotherapy regimens do not seem to increase survival in patients with HIV‐associated PBL. Cancer 2012. © 2012 American Cancer Society.

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

“…Our univariate analysis showed that age <60 years and low stage were associated with better OS. Although the use of cART in HIV-positive patients has been reported to improve outcomes among PBL patients [15], our findings and those of others have not been able to confirm the prognostic value of cART [20]. Additionally, in contrast to previous reports, we were unable to confirm the detrimental effect of MYC gene rearrangements in our patient cohort [5, 13, 20].…”

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

“…Ki67 activity is typically very high (> 90%). MYC positivity is present in over 50% of cases, reflecting underlying translocation amplification within tumor cells [8,9,10]. EBER is positive in 70% [2].…”

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

“…The diagnosis of PBL carries a very poor prognosis for both HIV-positive and -negative patients, with survival rarely exceeding 1 year despite therapy [10,12]. In HIV-positive PBL, multiple prognostic factors such as performance status, clinical stage, IPI score, myc rearrangement, and complete response to chemotherapy will have an impact on progression-free survival (PFS) and overall survival (OS) [10,12].…”

“…In HIV-positive PBL, multiple prognostic factors such as performance status, clinical stage, IPI score, myc rearrangement, and complete response to chemotherapy will have an impact on progression-free survival (PFS) and overall survival (OS) [10,12]. …”