Plasmablastic lymphoma in Johannesburg, South Africa, in the era of widescale antiretroviral therapy use

Abstract

Objectives Plasmablastic lymphoma (PBL) is a clinically aggressive lymphoma which has a predilection for extranodal sites and is frequently HIV‐associated. The incidence of non‐Hodgkin lymphoma is thought to be reduced by widescale antiretroviral therapy (ART) coverage, but the literature is sparse as regards the impact of ART on the incidence of PBL and its outcomes in South Africa (SA). This study aimed to compare factors of interest in cases of PBL diagnosed before and after the widespread availability of ART in Johannesburg, SA. Methods All cases of PBL diagnosed in the state sector hospitals of Johannesburg in 2007 and 2017 (before and after the widespread availability of ART, respectively) were extracted from the laboratory information system, and factors of interest compared. Results The majority (> 95%) of cases of PBL were seen among people with HIV infection (PWH) at both time‐points, and the proportion of patients on ART and with virological suppression (VS) increased significantly in 2017. However, the number of cases of PBL did not differ significantly between the two years assessed, comprising 46/397 (11.6%) and 53/582 (9.6%) of all lymphomas in 2007 and 2017, respectively (P = 0.23). Ongoing risk for PBL among PWH with virological control and immunological recovery was evident in 2017, as 18.9% of the patients had both VS and CD4 counts > 200 cells/μL at diagnosis. Inferior survival times were associated with elevated lactate dehydrogenase (LDH) levels and Epstein Barr virus (EBV) negativity, but were not influenced by the presence of AIDS, ART or VS. EBV negativity was significantly associated with VS, and appeared to flag a particularly aggressive form of the disease. Conclusions Widescale ART coverage has not reduced the incidence of PBL in Johannesburg, and an ongoing risk for this disease among PWH with adequate virological control and immunological recovery persists.

HIV‐associated plasmablastic lymphoma: A single‐centre 12‐year experience in Kwa‐Zulu Natal, South Africa

“…The development of PBL is unlikely to be related solely to high viral loads because approximately 20% of patients had undetectable viral loads at presentation in this study. These findings concur with another South African study [24] and a German study [12]. This contrasts with Mai et al [43], who postulated that the high incidence of PBL in their study may have been associated with poor control of HIV.…”

“…The EBER findings in our study cohort are within the EBER 75–100% positivity range described in the literature [15,20]. Although the prognostic value of EBER yields conflicting results, the poor survival outcome of < 2 months in the single EBER‐negative patient would support the inferior outcome reported in EBER‐negative HIV PBL [15,24].…”

“…Despite the high HIV seroprevalence in KZN, there are no data on the profile, prognosis and outcome of HIV-associated PBL in KZN. Of the four sub-Saharan African studies, three are from other South African provinces [24][25][26] and the fourth is a small study of six patients in Malawi [27]. This would be the first such report from KZN, the epicentre of the HIV epidemic in South Africa.…”

“…KwaZulu-Natal is recorded to have the highest HIV seroprevalence, at 18% [23]. Although PBL also occurs in other immunocompetent patients, with incidence rates as high as 44% [15,20], in Gauteng, another South African province, over 95% of PBL cases were seen in HIV-positive patients [24]. Despite the high HIV seroprevalence in KZN, there are no data on the profile, prognosis and outcome of HIV-associated PBL in KZN.…”

Plasmablastic lymphoma: An update

“…A higher frequency of nodal and skin involvement is reported in immunosuppressed patients post‐transplantation, as compared to other PBL subgroups 1,2,17 . Nodal disease without extra‐nodal involvement is rare, though it has been reported 8 . Extranodal sites reported in >1% of PBL cases include the genitourinary tract, central nervous system, bone, liver, nasal cavities, lung, and orbits.…”