Regression of a Plasmablastic Lymphoma in a Patient with HIV on Highly Active Antiretroviral Therapy

Abstract

We describe an HIV-infected 44-year-old man who presented 1 month after discontinuation of HAART therapy with a large mass extending from the mediastinum, enclosing the heart and extending through the diaphragm to the epigastric region. Biopsies subsequently revealed a highly aggressive non-Hodgkin's lymphoma (NHL) producing sheets of cells with an organoid distribution. The cells had abundant basophilic cytoplasm and a plasmacytic appearance. Although immunohistochemistry failed to show either B- or T-cell markers, antigens consistent with plasma cells were found. An immunoglobulin heavy chain clonal rearrangement was identified by PCR analysis. These studies were supportive of a diagnosis of a plasmablastic lymphoma. While awaiting the results of these tests, the patient was reinitiated on his HAART regimen. He was found on follow-up a month later to have complete resolution of his bulky mediastinal mass. He remained free of disease for 3 months with subsequent rectal and abdominal recurrence. Treatment with CHOP chemotherapy with filgrastim support was begun which resulted in another remission. Plasmablastic lymphoma is now reported in some studies to account for 2.6% of all HIV-related NHL. Originally described in 1997 in a series of 16 patients, this entity is highly associated with HIV infection in its later stages. Often, patients present with oral or jaw lesions with a rapidly progressive course. The tumors have the morphologic appearance of a plasmacytoid tumor with high proliferative index. Markers are positive mainly for LCA, CD79a, VS38C, and CD138. Co-infection with HHV-8 and EBV has not been consistently reported. Therapy with standard regimens has variable response. One case has been reported with a 3.5 year disease free survival. The regression of disease after resumption of HAART therapy alone in this patient suggests that HAART has an important role in the treatment of lymphoma in the HIV infected patient.

Cytologic features of plasmablastic lymphoma

“…Others have also reported very short survival times. 10,21,22 However, in the series by Feldstein et al, 11 the median survival appears to be higher than reported by the other authors. The lack of a standard treatment and better HIV management of these patients could account for differences in survival.…”

HIV‐associated plasmablastic lymphoma: Lessons learned from 112 published cases

“…Cases of plasmablastic microlymphoma, an emerging phenomenon described in HIV-infected patients often with preexistent multicentric Castleman disease, were excluded from this study. HHV8-positive PBL cases were also excluded from the analysis as great controversy in the present literature exists as to the role of this oncovirus in PBL pathogenesis [38,39,[48][49][50][51]. Unpublished data and cases reported in abstract form only were also excluded.…”

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

“…The clinical course of PBL is characteristically aggressive, with a reported median overall survival (OS) time of 15 months [2]. However, spontaneous regression with antiretroviral therapy (ART) has been reported [3][4][5], as well as prolonged and durable responses to chemotherapy [6 -10].…”