Primary Effusion Lymphoma: Is Dose-Adjusted-EPOCH Worthwhile Therapy?

Jessamy, Kegan; Ojevwe, Fidelis; Doobay, Ravi; Yu, John S.; Lemke, Sheila

doi:10.1159/000446315

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…There is no standard first-line treatment for PEL, and the available therapies present very poor results. Treatment with CHOP has achieved responses of 20–50% [ 155 ], while DA-EPOCH increases the complete response ratio and prolongs OS in patients with HIV-related PEL [ 140 , 159 , 160 ]. There is no established second-line treatment, but ASCT can be a therapeutic option, given the poor prognosis of this lymphoma [ 161 , 162 ].…”

Section: Implications Of Epstein–barr Virus In the Different Hiv-related Lymphoma Typesmentioning

confidence: 99%

Clinical and Therapeutic Implications of Epstein–Barr Virus in HIV-Related Lymphomas

Verdu-Bou

Tapia

Hernández-Rodríguez

et al. 2021

Cancers

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The incidence of lymphomas is increased in people living with HIV (PLWH). Aggressive B-cell non-Hodgkin lymphomas (NHLs) are the most common and are considered an AIDS-defining cancer (ADC). Although Hodgkin lymphoma (HL) is not considered an ADC, its incidence is also increased in PLWH. Among all HIV-related lymphomas (HRL), the prevalence of Epstein–Barr virus (EBV) is high. It has been shown that EBV is involved in different lymphomagenic mechanisms mediated by some of its proteins, contributing to the development of different lymphoma subtypes. Additionally, cooperation between both HIV and EBV can lead to the proliferation of aberrant B-cells, thereby being an additional lymphomagenic mechanism in EBV-associated HRL. Despite the close relationship between EBV and HRL, the impact of EBV on clinical aspects has not been extensively studied. These lymphomas are treated with the same therapeutic regimens as the general population in combination with cART. Nevertheless, new therapeutic strategies targeting EBV are promising for these lymphomas. In this article, the different types of HRL are extensively reviewed, focusing on the influence of EBV on the epidemiology, pathogenesis, clinical presentation, and pathological characteristics of each lymphoma subtype. Moreover, novel therapies targeting EBV and future strategies to treat HRL harboring EBV are discussed.

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Section: Implications Of Epstein–barr Virus In the Different Hiv-related Lymphoma Typesmentioning

confidence: 99%

Clinical and Therapeutic Implications of Epstein–Barr Virus in HIV-Related Lymphomas

Verdu-Bou

Tapia

Hernández-Rodríguez

et al. 2021

Cancers

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“…PEL is usually resistant to chemotherapy and has a worse prognosis. Without treatment, median survival is 2 to 3 months 14 . Conventional chemotherapy regimens for NHL such as cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or etoposide, prednisone, oncovorin, cyclophosphamide, hydroxydaunorubicin (EPOCH) are commonly used for the treatment of PEL but still the prognosis remains grim 13 .…”

Section: Discussionmentioning

confidence: 99%

“…Without treatment, median survival is 2 to 3 months. 14 Conventional chemotherapy regimens for NHL such as cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) or etoposide, prednisone, oncovorin, cyclophosphamide, hydroxydaunorubicin (EPOCH) are commonly used for the treatment of PEL but still the prognosis remains grim. 13 Therefore, there is need for further evaluation of current treatment options and development of improved targeted therapies for this rare malignancy.…”

Section: Discussionmentioning

confidence: 99%

A rare case of primary effusion lymphoma in HIV negative patient: Diagnostic challenges and literature review

Malik

Khader

Asiry

2021

Diagnostic Cytopathology

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We present a rare case of primary effusion lymphoma (PEL) in a 75 year old, HIV‐negative male patient with multiple comorbidities. Imaging studies revealed a massive right pleural effusion and a significant lung collapse with multiple plural soft tissue nodules. Immediate thoracentesis was performed. Cytologic evaluation of the pleural fluid showed abnormally large cell with increased nuclear to cytoplasmic ratio, irregular nuclear contours and prominent nucleoli, with phenotypic expression of HHV‐8, CD138, CD30, and MUM1 markers and negative staining for epithelial and mesothelial markers. PEL is a rare and aggressive large B‐cell lymphoma often affecting immunocompromised adults and is mostly associated with human herpes virus 8/Kaposi sarcoma‐associated herpes virus (HHV‐8/KSHV). However, cases in immunocompetent elderly patients have been reported. The cytomorphologic features of PEL overlaps with those of aggressive lymphomas such as diffuse large B‐cell lymphoma, plasmablastic lymphoma, and anaplastic large‐cell lymphoma. Also, mesothelioma, metastatic carcinoma or melanoma should be considered in the differential diagnosis. Hence, PEL should be kept in mind in the diagnostic algorithm of cytological evaluation of serosal fluid not only in HIV positive patients but also HIV‐negative elderly patients. In this report, we aim to highlight the cytologic and immunohistochemical staining pattern of this rare entity to increase awareness of this entity among cytopathologists.

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“…Specifically, doxorubicin and etoposide interact with topoisomerase II to inhibit DNA synthesis [52]; cyclophosphamide directly cross-links guanine bases in DNA double-helix strands to prevent DNA and RNA synthesis [53]; and vincristine stops tubulin dimer polymerization and subsequent microtubule formation by binding to the tubulin protein for inhibition of mitosis and protein metabolism [54]. Of interest, PEL usually displays more resistance to CHOP-based regimens than DA-EPOCH [22,55,56].…”

Section: Kshv-associated Lymphomamentioning

confidence: 99%

Mechanistic Insights into Chemoresistance Mediated by Oncogenic Viruses in Lymphomas

Chen

Kendrick

Qin

2019

Viruses

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Viral lymphomagenesis induced by infection with oncogenic viruses, such as Kaposi’s sarcoma associated herpesvirus (KSHV), Epstein–Barr virus (EBV) and human T-cell leukemia virus (HTLV-1), represents a group of aggressive malignancies with a diverse range of pathological features. Combined chemotherapy remains the standard of care for these virus-associated lymphomas; however, frequent chemoresistance is a barrier to achieving successful long-term disease-free survival. There is increasing evidence that indicates virus-associated lymphomas display more resistance to cytotoxic chemotherapeutic agents than that observed in solid tumors. Although the tumor microenvironment and genetic changes, such as key oncogene mutations, are closely related to chemoresistance, some studies demonstrate that the components of oncogenic viruses themselves play pivotal roles in the multidrug chemoresistance of lymphoma cells. In this review, we summarize recent advances in the understanding of the mechanisms through which oncogenic viruses mediate lymphoma cell chemoresistance, with a particular focus on KSHV and EBV, two major oncogenic viruses. We also discuss the current challenges to overcome these obstacles in the treatment of virus-associated lymphomas.

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Primary Effusion Lymphoma: Is Dose-Adjusted-EPOCH Worthwhile Therapy?

Cited by 6 publications

References 13 publications

Clinical and Therapeutic Implications of Epstein–Barr Virus in HIV-Related Lymphomas

Clinical and Therapeutic Implications of Epstein–Barr Virus in HIV-Related Lymphomas

A rare case of primary effusion lymphoma in HIV negative patient: Diagnostic challenges and literature review

Mechanistic Insights into Chemoresistance Mediated by Oncogenic Viruses in Lymphomas

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