Clinical and pathological aspects of human immunodeficiency virus-associated plasmablastic lymphoma: analysis of 24 cases

Abstract

Plasmablastic lymphoma (PBL) is a rare AIDS-related malignancy with a poor prognosis. Little is known about this entity, and no standard treatment regimen has been defined. To establish an adequate treatment strategy, we investigated 24 cases of PBL arising in human immunodeficiency virus-positive individuals. Most of the patients were in the AIDS stage, with a median CD4 count of 67.5/µL. Lymph nodes (58 %), gastrointestinal tract (42 %), bone marrow (39 %), oral cavity (38 %), and CNS (18 %) were the most commonly involved sites. Histology findings for the following were positive at varying rates, as follows: CD10 (56 %); CD30 (39 %); CD38 (87 %); MUM-1 (91 %); CD138 (79 %); EBER (91 %); and LMP-1 (18 %). There was a marked increase in patients in 2011-12, and the cases found in that period appeared to be more aggressive, showing a higher rate of advanced-stage PBL. Fourteen cases were treated with CHOP, while the others were treated with more intensive regimens, including bortezomib and hematopoietic stem cell transplantation. The overall median survival time was 15 months. A CD4 count of >100/µL at diagnosis and attaining complete remission in the first-line chemotherapy were associated with better outcomes (P = 0.027 and 0.0016, respectively). Host immune status and chemosensitivity are associated with improved prognosis in PBL.

Clinicopathological analysis of oral plasmablastic lymphoma: A systematic review

“…Most of the oral PBL presented as asymptomatic swellings, frequently associated with ulcerations and bleeding. B‐symptoms were absent in most cases, suggesting a more local involvement of the disease in most of the cases, what is consistent with the large number of cases classified as Ann Arbor stage I, although stage IV diseases were also frequent . A previous review of 228 cases of PBL also revealed a similar result, although the majority of cases involved extraoral sites …”

“…The low survival rates found for oral PBL were similar to the reported previously when all sites were considered . Nevertheless, prognostic factors described by previous studies that investigated PBL of different anatomical locations needs to be validated for tumors manifesting in the oral cavity and gnathic bones, what is especially difficult due to the limited number of cases available …”

“…However, these results must be validated by original studies, given the methodological limitations of this analysis that aggregated cases treated in many different medical centers and with different management protocols. Loghavi et al and Morscio et al also showed that EBV‐negative cases presented a better outcome, but Castillo et al and Koizumi et al did not find a significant association between B‐symptoms and patients survival.…”

Extraoral plasmablastic lymphomas in a high human immunodeficiency virus endemic area

“…The CD10 positivity noted in some cases (35.3%) reflects that previously described in PBL (42%, 56%, and 67%) . CD10‐positive cases expressed markers of plasma cell differentiation: all cases expressed VS38c and/or MUM1/IRF4, and 50% expressed BLIMP1.…”

“…2,20,34 The CD10 positivity noted in some cases (35.3%) reflects that previously described in PBL (42%, 56%, and 67%). 29,35,36 CD10-positive cases expressed markers of plasma cell differentiation: all cases expressed VS38c and/or MUM1/IRF4, and 50% expressed BLIMP1. The occasional CD3 positivity (n = 2), regarded as aberrant, has been rarely described in DLBCL and PBL.…”