Prognostic Factors in Chemotherapy-Treated Patients with HIV-Associated Plasmablastic Lymphoma

Castillo, Jorge J.; Winer, Eric S.; Stachurski, Dariusz; Perez, Kimberly; Jabbour, Melhem; Milani, Cannon; Colvin, Gerald A.; Butera, James N.

doi:10.1634/theoncologist.2009-0304

Cited by 115 publications

(142 citation statements)

References 25 publications

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“…HIV-positive patients treated with highly active antiretroviral therapy (HAART) and appropriate chemotherapy has a better overall survival than HIVnegative patients [4,10,11]. HIV-associated PBL remains poor prognosis pathology and the impact of more intensive chemotherapeutic regimens in the ART era is not evident [7]. One study found a median overall survival in HIV-positive patients of 10 months [11].…”

Section: Discussionmentioning

confidence: 99%

“…Epstein-Barr virus (EBV) infection has been detected in 74% of published PBL cases [7]. EBV can be detected by EBER in situ hybridization, Epstein-Barr virus latent membrane protein 1 (LMP1) is not expressed.…”

Section: Pathologic Featuresmentioning

confidence: 99%

“…The role of Human Herpes Virus 8 (HHV8) in the pathogenesis of PBL is uncertain [7] and PBL is not included in KSHV/HHV8-associated lymphomas defined by WHO. In a large cohort study, around 30% of HIV positive homosexual men were seropositive for HHV8 [14] but several studies have found that PBLs of the oral cavity type do not contain KSHV [15].…”

Section: Pathologic Featuresmentioning

confidence: 99%

“…It usually occurs in the oral cavity or jaw of human immunodeficiency virus (HIV) infected individuals [3]. More recently, however, several cases of PBL involving extraoral sites have been reported in immunocompetent individuals [4][5][6][7]. PBL is a diagnostic challenge given its morphology and its immunohistochemical profile.…”

Section: Introductionmentioning

confidence: 99%

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Plasmablastoid Lymphoma in Patients with Human Immunodeficiency Virus: A Diagnosis Challenge

Jelloul¹,

Sattar²,

Wind³

et al. 2017

J Emerg Infect Dis

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In this era of Highly Active Antiretroviral Therapy (HAART), we see that incidence of neoplasic diseases among patients affected by Human Immonudeficiency Virus (HIV) is increasing. Plasmablastic lymphoma (PBL) is an example of neoplastic condition specific to HIV patients. It is a subtype of diffuse large B-cell lymphoma (DLBCL) recently described in the 2008 WHO classification of lymphoproliferative disorder. PBL is characterized by its aggressive nature and plasmacytic differentiation and usually occurs in the oral cavity or jaw of HIV-infected individuals. However, several cases of PBL involving extraoral sites have been reported in immunocompetent individuals. This entity is a diagnostic challenge and need integration of clinical, pathological, genetic and microbiologic features. Several types of lymphoma present with plasmablastoid differenciation and may give rise to some difficulties for a differential diagnosis. We give some anatomopathological, molecular and genetic details for each subtype and we will illustrate the difficulty for the diagnosis with two cases. The first case is a patient with plasmablastic lymphoma that present with unusual negative immunoreactivity for CD 138 (10% of PBL cases). The second case has clinical, epidemiological and pathological characteristic of plasmablastic lymphoma but HHV8 positivity is a criteria for considering extra-cavitary PEL as the most relevant diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Pathologic Featuresmentioning

confidence: 99%

Section: Pathologic Featuresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Plasmablastoid Lymphoma in Patients with Human Immunodeficiency Virus: A Diagnosis Challenge

Jelloul¹,

Sattar²,

Wind³

et al. 2017

J Emerg Infect Dis

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“…To date the prognostic and predictive significance of CD20 expression in lymphoma patients remains controversial and a matter of ongoing debate. Some clinical studies found no significant association between the CD20 expression and the outcome (10,11), whereas the others reported a significantly better clinical outcome in patients whose tumors were CD20 positive (12)(13)(14)(15). For this purpose, we assessed the relationship between the level of CD20 expression and OS, DFS along with response quality in B-cell lymphoma patients.…”

Section: Discussionmentioning

confidence: 99%

Predictive significance of the cut-off value of CD20 expression in patients with B-cell lymphoma

Novakovic¹

2010

Oncol Rep

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Abstract. The introduction of the anti-CD20 monoclonal antibody, rituximab, into the treatment of patients with B-cell lymphomas has improved the overall response rate, as well as the response duration and the overall survival of these patients. However, only a few studies have addressed the question of whether higher CD20 expression parallels with better treatment outcomes. The aim of this study was to assess the relationship between the level of CD20 expression and overall survival (OS), disease-free survival (DFS) along with the overall response rate (ORR) in B-cell lymphoma patients. The ultimate objective of the study was to determine the cut-off value of CD20 expression together with the predictive significance of better outcome of rituximab treatment. One hundred and fourteen patients with different histological types of B-cell lymphomas treated with rituximab and chemotherapy between 2003 and 2007 were enrolled in the study. All patients had CD20 expression assessed prior to the beginning of treatment. The level of CD20 expression was determined by quantitative flow cytometric measurements, while the OS and DFS were evaluated by means of KaplanMeier survival curves. The cut-off value of CD20 expression, which predicts a better response to rituximab in patients with B-cell lymphomas, was determined at 25.000 molecules of equivalent soluble fluorochrome (MESF). Our data show that patients who achieved complete response after rituximab therapy had a significantly higher expression of the CD20 antigen (p=0.018) than those whose disease only stabilized after rituximab therapy. No significant difference was observed in the response duration between the patients with CD20 antigen expressed above the cut-off value and those expressing CD20 antigen below the cut-off value [hazard ratio (HR), 0.5667; 95%CI, 0.124 to 3.18, p=0.57]. Even though we have proved that patients with a CD20 expression level above the cut-off value treated with rituximab had a significantly longer OS [hazard ratio (HR), 0.4573; 95%CI, 0.1364 to 0.9461, p=0.0383] than patients with a CD20 expression level below the cut-off value. Among our study population, 17.5% had a CD20 expression level below the cut-off value. The highest percentage (80%) of the patients with a CD20 expression level below the cut-off value belonged to the group of chronic lymphocytic leukemia (CLL) patients, while the lowest (6.7%) was observed in the follicular lymphoma (FL) patient group. These data indicate that a higher level of CD20 expression correlates with an improved OS in patients treated with rituximab. The cut-off limit of CD20 expression suggested to have the predictive significance of better outcome was in our series set at 25.000 MESF. This cut-off value should be considered when the decision regarding treatment with rituximab is taken. However, these results warrant further studies on larger groups of patients.

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Survival analysis in treated plasmablastic lymphoma patients: a population‐based study

2020

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Herein we analyzed survival outcomes in chemotherapy-treated patients with plasmablastic lymphoma (PBL) diagnosed between 2010 to 2016 (n = 248). Data was acquired from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (April 2019 release based on November 2018 submission). The majority of patients were male (81.9%) and younger than 60 years (71.0%). Oral and gastrointestinal (GI) sites were the most frequent primary extranodal locations (23% and 19.4%, respectively). Oral primary location was inversely associated with presence of B symptoms and advanced Ann-Arbor stage. The 3-year and 5-year overall survival (OS) rates of treated PBL patients were 54% (95% CI: 46.5%-60.8%) and 52.8% (95% CI: 45.2%-59.8%). Three-year conditional survival for 2-year and 3-year survivors were 90.3% and 97.8%, overlapping the survival of a general population matched by age, sex and calendar year. In a multivariable analysis, oral primary location was associated with not only better OS (HR 0.43; 95% CI: 0.21-0.88, P = .021) but also better lymphoma-specific survival (LSS) (SHR 0.36; 95% CI: 0.15-0.86, P = .022); age ≥60 years was associated with shorter LSS (SHR 1.73; 95% CI: 1.02-2.96, P = .043). Seven registries granted access to HIV status (n = 93) where HIV infection was detected in 52.7% of cases. The HIV status did not affect survival outcomes in unadjusted and adjusted analyses. We identified clinical characteristics associated with survival and showed that treated PBL patients may achieve long-term survival. 1 | INTRODUCTION Plasmablastic lymphoma (PBL) is a rare aggressive non-Hodgkin lymphoma with unknown incidence. Plasmablastic lymphoma was first described as a distinct clinicopathological entity in 1997 by Delecluse et al. and was shown to be associated with HIV infection (15 of 16 cases), Epstein-Barr virus (EBV) infection (9 of 16 cases) and a predilection for oral cavity, particularly jaw mucosa. 1 Subsequently, PBL was described in non-HIV patients with primary involvement outside of the oral cavity and was incorporated as a distinct clinical lymphoma type into the latest World Health Organization lymphoma classification. 2 It is considered to be a subtype of large B-cell lymphoma with plasmablastic morphology and expression of plasma cell markers (CD79a, CD38, CD138 and MUM-1), but lacking expression of B-cell markers (CD20, PAX-5). 3 The differential diagnosis includes immunoblastic diffuse large B-cell lymphoma, ALK positive diffuse large B-cell lymphoma, HHV-8 positive large B-cell lymphoma, primary effusion lymphoma, plasmablastic or anaplastic multiple myeloma and undifferentiated carcinoma. 3-5 Nodal involvement and association with HIV and EBV are typical for PBL but not seen in plasma cell neoplasms. 5-7 Plasmablastic lymphoma is an aggressive lymphoma with overall survival (OS) ranging from 7 to 62 months, according to small Jorge A. Florindez and Juan Pablo Alderuccio contributed equally to this study.

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Prognostic Factors in Chemotherapy-Treated Patients with HIV-Associated Plasmablastic Lymphoma

Cited by 115 publications

References 25 publications

Plasmablastoid Lymphoma in Patients with Human Immunodeficiency Virus: A Diagnosis Challenge

Plasmablastoid Lymphoma in Patients with Human Immunodeficiency Virus: A Diagnosis Challenge

Predictive significance of the cut-off value of CD20 expression in patients with B-cell lymphoma

Survival analysis in treated plasmablastic lymphoma patients: a population‐based study

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