1
|
Hofer KD, Wolfensberger N, Bachofner A, Schneidawind C, Stühler C, Bühler MM, Abela IA, Müller NJ, Zenz T, Manz MG, Rösler W, Khanna N, Schneidawind D. B-cell maturation antigen-directed bispecific antibodies in plasmablastic lymphoma. Br J Haematol 2024. [PMID: 38782604 DOI: 10.1111/bjh.19571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Kevin D Hofer
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Nathan Wolfensberger
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Adrian Bachofner
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Corina Schneidawind
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| | - Claudia Stühler
- Infection Biology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Marco M Bühler
- Department of Pathology and Molecular Pathology, University Hospital Zürich, Zürich, Switzerland
| | - Irene A Abela
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
- Institute of Medical Virology, University of Zürich, Zürich, Switzerland
| | - Nicolas J Müller
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Markus G Manz
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Wiebke Rösler
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Nina Khanna
- Infection Biology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Basel, Basel, Switzerland
| | - Dominik Schneidawind
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
- Department of Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Ramirez-Gamero A, Martínez-Cordero H, Beltrán BE, Florindez J, Malpica L, Castillo JJ. Plasmablastic lymphoma: 2024 update on diagnosis, risk stratification, and management. Am J Hematol 2024. [PMID: 38767403 DOI: 10.1002/ajh.27376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/06/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
DISEASE OVERVIEW Plasmablastic lymphoma (PBL) is a rare CD20-negative aggressive lymphoma with a poor prognosis under standard treatment options. Though PBL is associated with human immunodeficiency virus infection and other immunosuppressed states, it can also affect immunocompetent individuals. DIAGNOSIS The diagnosis requires a high clinical suspicion and pathological confirmation. EBER expression and MYC gene rearrangements are frequently detected. The differential diagnosis includes EBV+ diffuse large B-cell lymphoma, extracavitary primary effusion lymphoma, ALK+ DLBCL, and HHV8+ large B-cell lymphoma, among others. RISK STRATIFICATION Age ≥60 years, advanced clinical stage, and high intermediate and high International Prognostic Index scores are associated with worse survival. MANAGEMENT Combination chemotherapy regimens, such as EPOCH, are recommended. The addition of bortezomib, lenalidomide, or daratumumab might improve outcomes. Including PBL patients and their participation in prospective clinical trials is warranted.
Collapse
Affiliation(s)
- Andres Ramirez-Gamero
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Brady E Beltrán
- Department of Oncology and Radiotherapy, Hospital Edgardo Rebagliati Martins and Instituto de Ciencias Biomedicas, Universidad Ricardo Palma, Lima, Peru
| | - Jorge Florindez
- Division of Hematology and Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Luis Malpica
- Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jorge J Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Hansen AR, Vardell VA, Fitzgerald LA. Epidemiologic Characteristics, Treatment Patterns, and Survival Analysis of Plasmablastic Lymphoma in the United States: A SEER and NCDB Analysis. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2024; 24:e152-e160.e3. [PMID: 38262787 DOI: 10.1016/j.clml.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Plasmablastic Lymphoma (PBL) is a rare aggressive B-cell lymphoma that primarily affects immunocompromised individuals, including those living with HIV. Historically, survival estimates are dismal and range from 8 to 15 months. We aimed to evaluate epidemiologic characteristics, treatment patterns and survival trends on a national scale. PATIENTS AND METHODS Patients diagnosed with PBL from 2010 to 2020 were identified in the National Cancer Database (NCDB) and in the Surveillance, Epidemiology, and End Results (SEER) program. Incidence rates were calculated using SEER. Demographic features, treatment characteristics, and overall survival (OS) were identified using the NCDB. RESULTS We identified 1153 patients in the SEER database and 1822 patients in the NCDB. The incidence of PBL is 0.07 cases per 100,000 US population per year. PBL is more common in males (77%), and white patients (77%), with 50% of cases in patients with HIV. Patients who were treated with multiagent chemotherapy had a median OS of 58.6 months. On multivariate Cox regression, we found that HIV status did not have a significant impact on OS. Factors associated with worse OS included advancing age and stage. CONCLUSION We present the largest study to date on PBL. Among treated patients, we described a median OS of 58.6 months, greatly improved from previously reported estimates. We found that HIV status did not have a significant impact on OS. While OS remains poor, therapeutic advances over the last decade are promising and highlight the need for continued clinical advances aimed at improving therapeutic options for this rare lymphoma.
Collapse
Affiliation(s)
- Alec R Hansen
- Department of Internal Medicine, University of Utah, Salt Lake City, UT.
| | - Victoria A Vardell
- Department of Internal Medicine, University of Utah, Salt Lake City, UT; Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Lindsey A Fitzgerald
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| |
Collapse
|
4
|
Śluzar P, Reekhaye A, MacAskill F, Ong M, Rose V, Yap T. A rare case of an extra-oral plasmablastic lymphoma presenting through a scrotal abscess in a 42-year-old man. Ann R Coll Surg Engl 2024; 106:391-394. [PMID: 37051763 PMCID: PMC10981984 DOI: 10.1308/rcsann.2022.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 04/14/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare lymphoid neoplasm frequently presenting in the oral cavity. It is an aggressive type of non-Hodgkin's lymphoma that shares pathological features with plasma cell myeloma. In addition to human immunodeficiency virus (HIV), it is also associated with Epstein-Bar virus (EBV) and immunosuppression in HIV-negative patients, for example, post transplantation. Extra-oral PBL is rare and only a few case reports involving the testis have been described. Here we describe the first reported case of PBL presenting with a scrotal abscess (not involving the testes) in a patient newly diagnosed with HIV. This case highlights the rare presentation of a rare disease, the difficulties in establishing a diagnosis and the importance of a timely multidisciplinary approach to its management.
Collapse
Affiliation(s)
| | - A Reekhaye
- Guy’s and St Thomas’ NHS Foundation Trust, UK
| | | | - M Ong
- Guy’s and St Thomas’ NHS Foundation Trust, UK
| | - V Rose
- Guy’s and St Thomas’ NHS Foundation Trust, UK
| | | |
Collapse
|
5
|
Gietzen R, Muthukumarana V, Bhargava P, Vozniuk D, Thakral B, Medeiros LJ, Lyapichev KA. From the archives of MD Anderson Cancer Center: Plasmablastic lymphoma presenting as a kidney mass in an immunocompetent patient: Case report and literature review. Ann Diagn Pathol 2023; 67:152186. [PMID: 37541853 DOI: 10.1016/j.anndiagpath.2023.152186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a rare, aggressive large B-cell lymphoma with plasmablastic or immunoblastic morphology and a terminally differentiated B-cell immunophenotype. PBL often presents at extranodal sites, commonly the oral cavity of immunocompromised patients with human immunodeficiency virus (HIV) and/or Epstein-Barr virus (EBV) infection. Cases of PBL arising outside the oral cavity in previously healthy immunocompetent patients are rare. CASE REPORT We report a 65-year-old HIV- and EBV-negative man who presented with abdominal pain, fatigue, and vomiting. Imaging studies showed a 30 × 18 cm bulky lobulated mass located within the left kidney with surrounding para-aortic lymphadenopathy. Serum and urine protein electrophoresis revealed a monoclonal gammopathy of IgA lambda type. Biopsy of the mass showed PBL. Bone marrow lumbar puncture evaluations also showed evidence of PBL. The patient was treated with chemotherapy and radiation with initial improvement; however, he died 14 months after initial diagnosis. CONCLUSIONS Based on our literature review, this case of PBL is one of the few reported to present as a kidney mass in immunocompetent, HIV- and EBV-negative patient. Distinguishing PBL from plasma cell myeloma (PCM) can be challenging. Knowledge of clinical features including presence of CRAB (hypercalcemia, renal failure, anemia, bone lesions) or bone marrow infiltration by mature clonal plasma cells is helpful to establish a diagnosis of PCM. Genetic features of PCM (typical translocations or mutations) also can be helpful in distinguishing plasmablastic transformation of PCM and from PBL. The case we report also highlights the need for more studies to identify specific immunohistochemical and molecular markers to improve PBL diagnosis in immunocompetent patients.
Collapse
Affiliation(s)
- Rachelle Gietzen
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Peeyush Bhargava
- Department of Radiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Dmitrii Vozniuk
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kirill A Lyapichev
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA.
| |
Collapse
|
6
|
Fu Z, Wang H, Lauwers GY, Jiang K, Jayaratne NL, Bridglal S, Dong N, Wang E, Chen L, Barclift DP, Zhang L. Primary plasmablastic lymphoma of the gastrointestinal tract: A series of 13 HIV-negative cases and a review of literature. Ann Diagn Pathol 2023; 67:152204. [PMID: 37639839 DOI: 10.1016/j.anndiagpath.2023.152204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
CONTEXT Primary gastrointestinal plasmablastic lymphoma (GI-PBL) is a rare variant of diffuse B-cell lymphoma with an aggressive clinical course. PBL was initially reported among HIV-positive patients; however, subsequent studies have shown that it also occurs among HIV-negative patients. Its clinical characteristics remain poorly understood. This study aims to retrospectively analyze the clinicopathological findings of primary GI-PBLs in HIV-negative patients. DESIGN Primary HIV-negative GI-PBL cases from 2008 to 2022 were reviewed. Clinicopathologic features and outcomes were analyzed. RESULTS The cohort of 13 patients had a male-to-female ratio of 9:1 (3 patients' genders not available), with an average age of 61 (range, 30-92) years. The most involved location was the colon (n = 7 [53.8 %]), followed by the small bowel (n = 3 [23.1 %]), stomach (n = 2 [15.4 %]), rectum (n = 1 [7.7 %]), and anus (n = 1 [7.7 %]). Most patients (n = 10 [77 %]) showed isolated GI tract involvement. Eight patients had chronic inflammatory and/or immunocompromised status, including 4 with inflammatory bowel disease (all of whom underwent treatment), 3 with post-organ transplant status, and 1 with irritable bowel syndrome. All cases exhibited cytokeratin-/CD20-/PAX-5-/CD138+ and/or MUM1+ immunophenotype. Based on available data, 8 of 11 (72.7 %) patients had Epstein-Barr virus reactivation. Among 11 patients with follow-up data, the mean follow-up duration was 13.5 (range, 3-40) months; at the end of follow-up, 45.5 % of patients (5 of 11 patients) showed complete remission after chemotherapy. CONCLUSION Primary HIV-negative GI-PBL occurs predominantly in the colon of relatively elderly males with immunosuppression. Its clinical course can be heterogenous, presenting a comorbidity with inflammatory bowel disease or post-organ transplantation status.
Collapse
Affiliation(s)
- Zhiyan Fu
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA; Department of Pathology, LSU Health Sciences Center New Orleans, New Orleans, LA 70112, USA
| | - Haibo Wang
- Department of Pathology, LSU Health Sciences Center New Orleans, New Orleans, LA 70112, USA
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Kun Jiang
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Nushani L Jayaratne
- Department of Pathology, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Sanjay Bridglal
- Department of Pathology, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Ning Dong
- Department of Hematological Malignancy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
| | - Endi Wang
- Department of Pathology, Duke University, Durham, NC 27710, USA
| | - Lugen Chen
- Department of Pathology, Tampa General Hospital, Tampa, FL 33606, USA
| | | | - Ling Zhang
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
| |
Collapse
|
7
|
Zhang Z, Ma Z, Zhang L, Zheng K, Hou L. Primary Plasmablastic Lymphoma of The Paranasal Sinuses: A Rare Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231213545. [PMID: 38032063 DOI: 10.1177/01455613231213545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and highly invasive type of non-Hodgkin's lymphoma. It is usually associated with immunosuppression and human immunodeficiency virus infection. PBL most commonly occurs in the oral cavity, lymph nodes, and in other extranodal sites. However, it rarely originates from bilateral sinuses. Herein, we report the case of a 59-year-old man diagnosed with primary PBL of the sinuses confirmed by endoscopic biopsy, imaging materials, histopathological examination, and immunohistochemistry. The patient underwent 4 cycles of chemotherapy and 22 rounds of radiation therapy for 8 months. Re-examination by sinus computed tomography revealed no obvious tumor tissue in the nasal cavity and sinuses, suggesting that treatment was effective. No local recurrence or distant metastasis was detected at 6-month follow-up after the end of treatment.
Collapse
Affiliation(s)
- Zhijuan Zhang
- Department of Otolaryngology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Zheng Ma
- Department of Otolaryngology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Liping Zhang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Kaizhi Zheng
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Li Hou
- Department of Otolaryngology, General Hospital of Ningxia Medical University, Yinchuan, China
| |
Collapse
|
8
|
Ren LY, Chen Q, Qiu FP, Jiang ZY, Wang XY, Zhang XL, Shi ZQ. Proliferative glomerulonephritis with monoclonal IgG Lambda deposits caused by plasmablastic lymphoma: a case report. BMC Nephrol 2023; 24:297. [PMID: 37803288 PMCID: PMC10559464 DOI: 10.1186/s12882-023-03351-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION As a very rare form of B-cell lymphoma, plasmablastic lymphoma (PBL) typically occurs in patients with underlying immunosuppression, including human immunodeficiency virus (HIV), organ transplantation, and autoimmune diseases. For HIV-positive patients, PBL normally originates in the gastrointestinal tract, especially from the oral cavity in most cases. It is extremely rare to find abdominal cavity involvement in PBL, and there has been no previously reported instance of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) attributed to monoclonal IgG (MIgG) lambda secreted by PBL. CASE PRESENTATION We report the case of an HIV-negative female with nephrotic syndrome, renal insufficiency, and multiple swollen lymph nodes. Ascitic fluid cytology revealed a high level of plasmablast-like lymphocytes with the restriction of lambda light chains. Besides, the renal biopsy revealed PGNMID, which could presumably be secondary to MIgG-lambda-secreting by PBL. MIgG-lambda-restricted expression was discovered earlier in the kidney tissue than in the blood. CONCLUSION The diagnostic landscape for PBL is notoriously intricate, necessitating a multifaceted and nuanced approach to mitigate the risks of erroneous identification.
Collapse
Affiliation(s)
- Ling-Yan Ren
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Qi Chen
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Feng-Ping Qiu
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Zhen-Yu Jiang
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Xiao-Yi Wang
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Xiao-Lan Zhang
- Department of Pathology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Zhan-Qin Shi
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China.
| |
Collapse
|
9
|
Kaur S, Kollimuttathuillam S. Plasmablastic Lymphoma: Past, Present, and Future. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e253-e259. [PMID: 37453866 DOI: 10.1016/j.clml.2023.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023]
Abstract
Plasmablastic Lymphoma is a rare large B-cell lymphoma with unique immunohistochemical and morphological features. It was most commonly associated with HIV infection; however, it's now seen in other immunosuppressed states like autoimmune conditions, post-transplant settings, and even in elderly immunocompetent individuals. Although rare, it is an aggressive lymphoma with unfavorable outcomes. The aim of this manuscript is to have an in-depth review of the current knowledge of epidemiology, pathophysiology, prognostic markers, and treatment approaches currently in use and in clinical trials for this challenging disease.
Collapse
Affiliation(s)
- Supreet Kaur
- University of Texas Health Science Center San Antonio, TX.
| | | |
Collapse
|
10
|
Wiemer L, Quan JR, Omman R. An Atypical Presentation of an Uncommon Malignancy: Plasmablastic Lymphoma Presenting As Recurrent Scrotal Abscesses. Cureus 2023; 15:e38879. [PMID: 37303424 PMCID: PMC10257366 DOI: 10.7759/cureus.38879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and extremely diagnostically challenging entity. We report a unique case of PBL in an adult male with a history of recurrent scrotal abscesses who presented with progressively worsening scrotal pain, swelling, and drainage. Pelvic CT demonstrated a large scrotal abscess with external draining tracts with foci of air. Surgical debridement revealed necrotic tissue throughout the abscess cavity, abscess wall, and scrotal skin. Immunohistochemical analysis of the scrotal skin specimen uncovered diffuse proliferation of plasmacytoid cells with immunoblastic features that stained positive for CD138, CD38, IRF4/MUM1, CD45, lambda restriction, and Epstein-Barr encoded RNA in situ hybridization (EBER-ISH) with high Ki-67 proliferation index greater than 90%. Taken together, these findings confirmed a diagnosis of PBL. Treatment with six cycles of infusional etoposide, prednisolone, vincristine, cyclophosphamide, and hydroxydaunorubicin (EPOCH-like regimen) was administered with subsequent positron emission tomography (PET)/CT confirmation of complete response. There was no clinical evidence of lymphoma recurrence at the time of follow-up six months later. Our case exemplifies the growing diversity of ways in which PBL may manifest and underscores the importance of a clinician's familiarity with this entity and its well-defined risk factor of immunosuppression.
Collapse
Affiliation(s)
- Layton Wiemer
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - J R Quan
- Oncology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
- Oncology, University of Florida Health, Jacksonville, USA
| | - Reeba Omman
- Pathology, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| |
Collapse
|
11
|
Ogiyama H, Murayama Y, Tsutsui S, Iwasaki T, Kuriyama D, Horiki M, Imanaka K, Kimura H, Inoue M, Iishi H. Plasmablastic lymphoma occurring in ulcerative colitis during treatment with immunosuppressive therapy. Clin J Gastroenterol 2023; 16:198-205. [PMID: 36609818 PMCID: PMC9821367 DOI: 10.1007/s12328-023-01754-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
A 53-year-old man who had a history of ulcerative colitis (UC) for 2 years underwent colonoscopy as regular follow-up. The results showed an elevated lesion in the descending colon, which was diagnosed as plasmablastic lymphoma (PBL) based on pathological findings. In situ hybridization for the Epstein-Barr virus-encoded RNA probe was positive. Fluorescence in situ hybridization revealed rearrangement of the MYC gene. He had been taking prednisolone, 5-aminosalicylic acid, azathiopurine, and ustekinumab at the diagnosis of PBL and had multiple prior therapies for UC including infliximab, tacrolimus, and tofacitinib due to steroid dependence. PBL is a rare aggressive B cell lymphoma initially described in the oral cavity of human immunodeficiency virus positive patients and it is suspected to have an association with immunocompromised status of patients. The number of cases of PBL in inflammatory bowel disease (IBD) patients is extremely rare. All these patients were administered immunosuppressive therapy including thiopurines or biologics. IBD patients with immunosuppressive therapy have a higher potential for developing lymphoproliferative disorders. Clinicians should be aware of the risk of lymphoma, including PBL.
Collapse
Affiliation(s)
- Hideharu Ogiyama
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan ,Departments of Gastroenterology, Ikeda Municipal Hospital, Ikeda, Osaka 563-8510 Japan
| | - Yoko Murayama
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan
| | - Shusaku Tsutsui
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan
| | - Tetsuya Iwasaki
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan
| | - Daisuke Kuriyama
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan
| | - Masashi Horiki
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan
| | - Kazuho Imanaka
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan
| | - Hayato Kimura
- Department of Pathology, Itami City Hospital, Itami, Hyogo 664-8540 Japan
| | - Megumu Inoue
- Department of Hematology, Itami City Hospital, Itami, Hyogo 664-8540 Japan
| | - Hiroyasu Iishi
- Departments of Gastroenterology and Hepatology, Itami City Hospital, 1-100, Koyaike, Itami, Hyogo 664-8540 Japan
| |
Collapse
|
12
|
Giuliano A, Lam SY, Flecher MC, Horta RS. Case report: Suspected plasmablastic lymphoma in a dog resembling the clinical presentation in humans. Front Vet Sci 2023; 10:1100942. [PMID: 36875999 PMCID: PMC9978506 DOI: 10.3389/fvets.2023.1100942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare form of lymphoma in people. PBL originates from plasmablasts and usually presents with swelling/mass in the mouth/neck. A 7-year-old Mongrel dog was presented for a large oral and neck mass. Cytology and histopathology were suggestive of a round cell tumor that was suspected to be lymphoma. An immunohistochemical (IHC) stain panel showed positive for CD18, thus supporting the diagnosis of round cell tumor, but negative for T- and B-cell lymphomas, CD3, CD20, and PAX-5. Other markers including cytokeratin AE1/3 (for epithelial cell origin), CD31 (for endothelial cells), SOX10 (for melanoma), IBa-1 (for histiocytic sarcoma), and CD117 (for mast cell tumor) were all negative. MUM-1 (for plasma cell differentiation) was strongly positive and CD79a (B cell and plasma cells) was also scantly positive. Based on the histopathology and immunohistochemistry results in combination with the clinical presentation, a suspected diagnosis of PBL was made. As per available literature, this is perhaps the first highly suspected case of PBL in a dog.
Collapse
Affiliation(s)
- Antonio Giuliano
- CityU Veterinary Medical Centre, City University of Hong Kong, Kowloon, Hong Kong SAR, China.,Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Sin Yan Lam
- Veterinary Emergency Center, Kennedy Town, Hong Kong SAR, China
| | - Mayra C Flecher
- Department of Veterinary Medicine, Universidade Vila Velha, Vila Velha, ES, Brazil
| | - Rodrigo S Horta
- Department of Veterinary Medicine and Surgery, Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
13
|
Muacevic A, Adler JR, Thakurdesai A. Extranodal Involvement of the Anorectal Region in an HIV-Positive Patient With Plasmablastic Lymphoma: A Case Report. Cureus 2022; 14:e33151. [PMID: 36726933 PMCID: PMC9884648 DOI: 10.7759/cureus.33151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/01/2023] Open
Abstract
Plasmablastic lymphoma (PbL) is a rare type of aggressive B-cell malignancy that has an extremely poor prognosis without chemotherapeutic treatment, requiring a high degree of suspicion for an early and accurate diagnosis. It has been classically described in patients infected with the human immunodeficiency virus (HIV). However, it accounts for only 2.6% of acquired immunodeficiency syndrome (AIDS)-related lymphomas. Extranodal involvement is most commonly seen within the oral cavity (44%). Involvement of the gastrointestinal tract (14%) is rare and can often be confused with other malignancies with plasmablastic features. We present a rare case of PbL in a 55-year-old male with HIV-AIDS (CD4 (cluster of differentiation 4) cell count of 128), who presented for evaluation of incidentally detected multiple liver masses and lytic lesions in the ribs. Further workup revealed evidence of a lesion with increased uptake in the anorectal region with fine needle aspiration (FNA) biopsy identifying the lesion as plasmablastic lymphoma.
Collapse
|
14
|
Clinical Features, Phenotypic Markers and Outcomes of Diffuse Large B-Cell Lymphoma between HIV-Infected and HIV-Uninfected Chinese Patients. Cancers (Basel) 2022; 14:cancers14215380. [PMID: 36358798 PMCID: PMC9655449 DOI: 10.3390/cancers14215380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/12/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The effect of HIV infection on the clinicopathological characteristics of diffuse large B-cell lymphoma (DLBCL) remains debatable. Methods: Fifty-three HIV-infected and ninety-three HIV-uninfected DLBCL patients were enrolled in the retrospective study by propensity score matching for sex, age, body mass index and international prognostic index (IPI) at a ratio of 1:2. The clinicopathological characteristics were compared between the two groups. Results: HIV-infected DLBCL patients had lower white blood cell counts [×109/L; 4.4 (3.4−5.6) vs. 6.1 (4.2−8.2), p < 0.001], platelet counts (×109/L; 184.7 ± 89.3 vs. 230.0 ± 113.9, p = 0.014) and serum albumin (g/L; 37.3 ± 6.9 vs. 41.3 ± 6.2, p < 0.001) but higher incidences of central nervous system (CNS) involvement (9.4% vs. 1.1%, p = 0.014), bone marrow involvement (24.5% vs. 11.5%, p = 0.044) and Epstein−Barr viremia (61.1% vs. 26.7%, p = 0.002) than HIV-uninfected patients. In terms of histopathology, HIV-infected patients had higher positivity of Epstein−Barr virus-encoded small RNA (EBER) (41.7% vs. 6.7%, p = 0.002), but lower CD20 (90.2% vs. 98.7%, p= 0.029) and CD79a (23.1% vs. 53.7%, p < 0.001) expression. The overall response rate (ORR) at the end of chemotherapy (70.2% vs. 87.8%, p= 0.012) and 1-year overall survival (OS) (61.7% vs. 84.2%, log-rank p = 0.006) in HIV-infected patients were significantly lower than those in HIV-uninfected patients. Multivariate analysis suggested IPI ≤2.0 [adjusted odds ratio (AOR) (95% confidence interval): 5.0 (1.2−21.2), p = 0.030] was associated with ORR, hypoalbuminemia [AOR: 3.3 (1.3−9.1), p = 0.018] and CNS involvement [AOR: 3.3 (1.0−10.5), p = 0.044] were associated with reduced 1-year OS in HIV-infected patients. Conclusion: HIV-infected DLBCL patients have unique blood profiles and phenotypic markers. Low ORR and 1-year OS were observed in HIV-infected DLBCL patients in our study, even in the HAART era.
Collapse
|
15
|
Bailly J, Jenkins N, Chetty D, Mohamed Z, Verburgh ER, Opie JJ. Plasmablastic lymphoma: An update. Int J Lab Hematol 2022; 44 Suppl 1:54-63. [PMID: 36074710 PMCID: PMC9545967 DOI: 10.1111/ijlh.13863] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/20/2022] [Indexed: 12/22/2022]
Abstract
Plasmablastic lymphoma (PBL) is a highly aggressive B cell non-Hodgkin lymphoma frequently associated with immunosuppression, particularly human immunodeficiency virus (HIV) infection. Although PBL is rare globally, South Africa has a high burden of HIV infection leading to a higher incidence of PBL in the region. Laboratory features in PBL may overlap with plasmablastic myeloma and other large B cell lymphomas with plasmablastic or immunoblastic morphology leading to diagnostic dilemmas. There are, however, pertinent distinguishing laboratory features in PBL such as a plasma cell immunophenotype with MYC overexpression, expression of Epstein-Barr virus-encoded small RNAs and lack of anaplastic lymphoma kinase (ALK) expression. This review aims to provide a summary of current knowledge in PBL, focusing on the epidemiology, pathophysiology, laboratory diagnosis and clinical management.
Collapse
Affiliation(s)
- Jenique Bailly
- Division of Haematology, Department of Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Nicholas Jenkins
- Division of Haematology, Department of Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Dharshnee Chetty
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Zainab Mohamed
- Department of Radiation Oncology, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Estelle R Verburgh
- Division of Haematology, Department of Internal Medicine, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Jessica J Opie
- Division of Haematology, Department of Pathology, Faculty of Health Sciences, University of Cape Town and National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
16
|
Jessa R, Chien N, Villa D, Freeman CL, Slack GW, Savage KJ, Scott DW, Sehn LH, Song KW, Gerrie AS. Clinicopathological characteristics and long-term outcomes of plasmablastic lymphoma in British Columbia. Br J Haematol 2022; 199:230-238. [PMID: 35961783 DOI: 10.1111/bjh.18399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022]
Abstract
Plasmablastic lymphoma (PBL) is an aggressive and rare subtype of non-Hodgkin lymphoma with no standard-of-care therapy. We reviewed all patients diagnosed with histologically confirmed PBL in British Columbia, Canada between 1997 and 2019. Overall, 42 patients were identified, including 15 (36%) positive for HIV and nine (21%) on chronic immunosuppression. Curative-intent treatment consisting primarily of cyclophosphamide, doxorubicin, vincristine and prednisone was administered to 31 patients, of which 74% achieved response, however 61% relapsed after a median of 7.5 months. At a median follow-up of eight years for the whole cohort, five-year progression-free survival (PFS) and overall survival (OS) were 18% [95% confidence interval (CI): 6%, 30%] and 22% (95% CI: 8%, 36%) with median eight and 15 months respectively. There were no differences in relapse rate (p = 0.962), PFS (p = 0.228) or OS (p = 0.340) according to immune status. For those treated with curative intent, five-year PFS and OS were 24% (95% CI: 8%, 40%) and 31% (95% CI: 13%, 49%) with median 18 and 27 months respectively. In this population-based cohort of PBL patients spanning 20 years, survival outcomes were poor. Ultimately, further research is needed to develop more effective treatment strategies and to improve survival for patients.
Collapse
Affiliation(s)
- Rehan Jessa
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Chien
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Diego Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciara L Freeman
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida, USA
| | - Graham W Slack
- Department of Pathology and Laboratory Medicine, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - David W Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin W Song
- Leukemia/Bone Marrow Transplant Program of BC and Division of Hematology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
17
|
Bortezomib, Lenalidomide and Dexamethasone Combination Induced Complete Remission in Relapsed/Refractory Plasmablastic Lymphoma: Case Report of a Potential Novel Treatment Approach. Curr Oncol 2022; 29:5042-5053. [PMID: 35877259 PMCID: PMC9323819 DOI: 10.3390/curroncol29070399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/10/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Plasmablastic lymphoma is a rare subtype of large B-cell lymphoma characterised by an aggressive clinical course with frequent relapses and refractoriness to chemotherapy. It is usually associated with HIV, however, it can also be seen in immunocompetent patients. It has distinct pathological characteristics, such as plasmablastic morphology and lack of CD20 expression. These characteristics pose a clinical and pathological challenge. There is no standard of care established in this entity. In this case report, we described a novel bortezomib-based plasma cell targeted regimen in a HIV-negative patient refractory to chemotherapy.
Collapse
|
18
|
Liu YC, Su YT, Huang CK, Tsai YC, Chen YC, Li PF. Unusual bilateral kidney and duodenal plasmablastic lymphoma presentation in an elderly patient: A case report. Mol Clin Oncol 2022; 17:122. [PMID: 35761897 PMCID: PMC9214482 DOI: 10.3892/mco.2022.2555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/01/2022] [Indexed: 11/06/2022] Open
Abstract
The present report described the case of a 71-year-old man who was admitted to the emergency department with a 7-day history of progressive left flank pain and tarry stool. Bedside point-of-care ultrasound of the left kidney showed lobulated ill-defined hypoechoic foci in the perirenal spaces with mild hydronephrosis. Subsequent contrast-enhanced abdominal computed tomography revealed lobulated low-density lesions in the bilateral perirenal space and paraaortic space. The patient was subsequently admitted to the internal medicine department of the hospital. Renal and duodenal biopsies were arranged, and pathology reports were consistent with the findings of plasmablastic lymphoma (PBL). This unusual presentation of flank pain and tarry stool caused by recurrent PBL highlighted that genitourinary or gastrointestinal manifestations could occur in cases of PBL recurrence. The patient received intensive chemotherapy regimens comprising a combination of etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin hydrochloride for aggressive non-Hodgkin's lymphoma to achieve a good response.
Collapse
Affiliation(s)
- Yi-Chen Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri‑Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yu-Te Su
- Department of Emergency Medicine, Tri‑Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Chih-Kang Huang
- Department of Emergency Medicine, Tri‑Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yu-Chi Tsai
- Department of Surgery, Tri‑Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yeu-Chin Chen
- Division of Hematology/Oncology, Tri‑Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Peng-Fei Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri‑Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| |
Collapse
|
19
|
Spontaneous Regression of Plasmablastic Lymphoma in an Immunocompetent Patient: Case Report and Review of the Literature. Case Rep Hematol 2022; 2022:1142049. [PMID: 35677531 PMCID: PMC9170507 DOI: 10.1155/2022/1142049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and highly aggressive type of lymphoma, which is commonly associated with human immunodeficiency virus (HIV) infection. Spontaneous regression of aggressive lymphomas is rare as they typically require administration of chemotherapy and radiotherapy for treatment. Here, we describe a case of a spontaneous regression of PBL after nasal biopsy and computed tomography (CT) guided biopsy of paravertebral mass in an immunocompetent patient. We postulate that the patient's immune system may be activated as a result of the stress and physical trauma brought on by nasal and paravertebral mass biopsy. Our case highlights the rare phenomenon of spontaneous regression of lymphoma which needs to be further studied on to establish its underlying pathophysiology.
Collapse
|
20
|
Zafar MH, Gil LC, Karimi S, Arain S, Niravel B, Martinolich J, Galvin J, Murga-Zamolloa CA, Gantt Jr. G. Plasmablastic Lymphoma Presenting With Rectosigmoid Perforation in a Human Immunodeficiency Virus-Positive Patient. Cureus 2022; 14:e24964. [PMID: 35706759 PMCID: PMC9187260 DOI: 10.7759/cureus.24964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/06/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare variant of diffuse large B-cell lymphoma (DLBCL) associated with human immunodeficiency virus (HIV)-positive patients. It accounts for only 2% of all acquired immune deficiency syndrome (AIDS)-related lymphomas (ARLs). We present the case of a 45-year-old male who presented to the emergency department (ED) with a three-month history of abdominal pain, diarrhea, and unintentional 50-lb weight loss. On an earlier presentation to the ED three months prior, the patient was diagnosed with norovirus and Helicobacter pylori infection and received outpatient treatment without resolution of his symptoms. This prompted further investigation with a CT of the abdomen and pelvis with IV contrast that revealed severe sigmoid colitis with pneumoperitoneum and a pericolonic air-containing fluid collection, consistent with a contained perforation with abscess formation. He was admitted, resuscitated, and initially treated with antibiotics and parenteral nutrition. The patient underwent a laparoscopic converted to open anterior resection with end colostomy. Pathology revealed HIV-related PBL. He was subsequently treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) chemotherapy regimen and an autologous stem cell transplant. Despite its rare association with HIV, PBL should be considered a differential diagnosis for HIV-positive patients who present with gastrointestinal (GI) pathology, and additional investigations should be conducted if symptoms do not resolve despite appropriate medical management at the time.
Collapse
|
21
|
M. GB, Jain R, Shah SS, Shaikh FA. Relapsed Plasmablastic Lymphoma in an HIV-Infected Patient—Experience of High-Dose Chemotherapy with Autologous Stem Cell Rescue: A Case Report with Review of Literature. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractPlasmablastic lymphoma (PBL) is a subtype of non-Hodgkin lymphoma with dismal outcome despite multidrug chemotherapy regimen leading to high rates of disease recurrence. High-dose chemotherapy with autologous stem cell rescue (HDCT/ASCR) is an effective salvage therapy in patients with chemo-sensitive human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma. We report a case of 38 years old male with relapsed PBL associated with underlying HIV infection, who underwent HDCT/ASCR. He presented with low-grade fever and abdominal discomfort. He was evaluated with fluorodeoxyglucose positron emission tomography scan followed by omental biopsy that confirmed disease relapse. He received second-line therapy containing bortezomib and daratumumab and achieved remission (CR2). Subsequently, he underwent HDCT/ASCR. He has been clinically asymptomatic in good general condition having disease-free survival of 18 months after HDCT/ASCR. Our objective of presenting this case report is its complexity from presentation, diagnosis, and treatment. We take this opportunity to review the epidemiology and clinicopathological characteristics of PBL, as well as discuss the advancements in therapeutic options of this challenging disease.
Collapse
Affiliation(s)
- Ganapathi Bhat M.
- Department of Medical Oncology & BMT, Jaslok Hospital & Research Centre, Mumbai, Maharashtra, India
| | - Reetu Jain
- Department of Medical Oncology & BMT, Jaslok Hospital & Research Centre, Mumbai, Maharashtra, India
| | - Samir S. Shah
- Department of Hemato Oncology & BMT, Jaslok Hospital & Research Centre, Mumbai, Maharashtra, India
| | - Fahad Afzal Shaikh
- Department of Medical Oncology & BMT, Jaslok Hospital & Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
22
|
DiBlasi M, Jayne C, McNamara R, Iasiello C, Colden D. Sinonasal Plasmablastic Lymphoma Arising in the Setting of Recurrent Nasal Polyposis in an Immunocompetent Individual. EAR, NOSE & THROAT JOURNAL 2022:1455613211070897. [PMID: 35001641 DOI: 10.1177/01455613211070897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive, rare variant of B-cell lymphoma typically associated with human immunodeficiency virus and other immunocompromised populations. Most commonly found in the oral cavity, PBL can occasionally originate in the sinonasal tract. Diagnosis of PBL is difficult due to overlapping features with other malignancies; however, early detection and treatment are imperative given its aggressive clinical course. When in the sinonasal tract, the diagnostic process can be further complicated if the patient has a history of recurrent nasal polyposis. Described is the case of a 57-year-old immunocompetent male who initially presented with benign nasal polyposis, only to return a year after sinus surgery with a unilateral sinonasal mass consistent with PBL. As literature has yet to characterize this phenomenon, this article presents the first case reported of sinonasal PBL arising in the setting of recurrent nasal polyposis. This case emphasizes the importance of investigating sinonasal masses showing laterality, maintaining a high index of suspicion for malignancy, and keeping close surveillance of the patient after treatment of PBL.
Collapse
Affiliation(s)
- Marco DiBlasi
- Colden and Seymour Ear, Nose, Throat, and Allergy, Newburyport, MA, USA
- 5980Anna Jaques Hospital, Newburyport, MA, USA
- 385266Boston Children's Hospital, Boston, MA, USA
| | - Christopher Jayne
- Colden and Seymour Ear, Nose, Throat, and Allergy, Newburyport, MA, USA
- 5980Anna Jaques Hospital, Newburyport, MA, USA
- 12282Creighton University School of Medicine, Omaha, NE, USA
| | - Reilly McNamara
- Colden and Seymour Ear, Nose, Throat, and Allergy, Newburyport, MA, USA
- 5980Anna Jaques Hospital, Newburyport, MA, USA
| | | | - Daryl Colden
- Colden and Seymour Ear, Nose, Throat, and Allergy, Newburyport, MA, USA
- 5980Anna Jaques Hospital, Newburyport, MA, USA
- Department of Otolaryngology - Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
23
|
Meer S, Perner Y, Willem P. Oral versus extra-oral plasmablastic lymphoma: A comparative analysis of 101 cases. J Oral Pathol Med 2021; 51:146-151. [PMID: 34910327 DOI: 10.1111/jop.13269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
AIMS Originally described exclusively orally in HIV-infected patients, plasmablastic lymphoma (PBL) is increasingly described extra orally and in non-HIV-infected persons. The study comparatively analysed the clinico-pathologic features of oral PBLs (n = 55) to previously published extra-oral PBLs (n = 45 + 1) diagnosed over a seven-year period at the same institution in an HIV prevalent setting in South Africa in order to clarify any distinction between oral and extra-oral PBLs. METHODS AND RESULTS Tumours were assessed histologically and immunohistochemically with CD45 (LCA), CD3, CD20, CD79a, PAX5, CD138, MUM1, BLIMP1, VS38c, Ki-67, BCL6 and CD10 using standard protocols. Age ranged from 22 to 76 years (oral) and 9 and 59 years (extra-oral). Most PBL patients were HIV positive [oral (84%); extra-oral (65%)]. Male:female ratio was 2.7:1 for oral and 1.4:1 for extra-oral PBLs. Favoured oral and extra-oral sites were the maxilla and anus. PBLs displayed an indistinguishable immunohistochemical profile with unusually high CD45 expression (oral: 98%, extra-oral: 84%). EBV assessed by chromogenic in situ hybridisation (ISH) showed positivity in all oral PBLs and 95% extra-oral PBLs. MYC rearrangements (fluorescence ISH MYC break-apart probe) were similar in all the PBLs. CONCLUSIONS Extra-oral PBL is identical to its oral counterpart in gender and age distribution, HIV status, morphological appearances, immunophenotypic profile and EBV association. PBL should be regarded as the same tumour irrespective of oral or extra-oral site of origin.
Collapse
Affiliation(s)
- Shabnum Meer
- Department of Oral Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yvonne Perner
- Department of Anatomical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pascale Willem
- Department of Hematology and Molecular Medicine, Somatic Cell Genetics Unit, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
24
|
Verdu-Bou M, Tapia G, Hernandez-Rodriguez A, Navarro JT. Clinical and Therapeutic Implications of Epstein-Barr Virus in HIV-Related Lymphomas. Cancers (Basel) 2021; 13:5534. [PMID: 34771697 PMCID: PMC8583310 DOI: 10.3390/cancers13215534] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/29/2021] [Indexed: 12/26/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Miriam Verdu-Bou
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Can Ruti Campus, 08916 Badalona, Spain;
| | - Gustavo Tapia
- Department of Pathology, Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | - Agueda Hernandez-Rodriguez
- Department of Microbiology, Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain;
| | - Jose-Tomas Navarro
- Lymphoid Neoplasms Group, Josep Carreras Leukaemia Research Institute, Can Ruti Campus, 08916 Badalona, Spain;
- Department of Hematology, Institut Català d’Oncologia-Germans Trias i Pujol Hospital, 08916 Badalona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| |
Collapse
|
25
|
Plasmablastic Lymphoma or Plasmablastic Myeloma: A Case of Post-Transplant Lymphoproliferative Disorder. Case Rep Hematol 2021; 2021:4354941. [PMID: 34616575 PMCID: PMC8490046 DOI: 10.1155/2021/4354941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Plasmablastic lymphomas and plasmablastic myelomas are malignancies with overlapping clinical and pathological features which pose a diagnostic dilemma and are known to be aggressive with a poor outcome. CD38 is a common immunophenotypic maker for both these malignancies and provides a rationale for using daratumumab-based regimes. We describe a 57-year-old male with a history of end-stage renal disease who underwent a deceased-donor renal transplant maintained on chronic immunosuppression who presented with ascites and was found to have abdominal adenopathy and a lytic lesion in the humerus and diagnosed with a post-transplant lymphoproliferative disorder with features intermediate between plasmablastic lymphoma and plasmablastic myeloma. The patient was subsequently treated with a daratumumab-based regime with an excellent response. This case highlights a rare scenario that poses a diagnostic and therapeutic challenge. As there is no standard of care for the treatment of both these malignancies, this case report also describes the use of daratumumab with a good long-term outcome, especially when the pathological distinction between the two entities is difficult.
Collapse
|
26
|
Fukuo Y, Shibuya T, Ashizawa K, Ito K, Saeki M, Fukushima H, Takahashi M, Nomura K, Okahara K, Haga K, Akazawa Y, Nomura O, Ogura K, Okubo H, Nagahara A. Plasmablastic Lymphoma of the Small Intestine in an HIV- and EBV-negative Patient. Intern Med 2021; 60:2947-2952. [PMID: 33776007 PMCID: PMC8502670 DOI: 10.2169/internalmedicine.6837-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare aggressive B-cell lymphoproliferative disorder that is strongly associated with immunodeficiency, most often with human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) infection, and that mainly occurs in the oral cavity. Although some clinical features can lead to a diagnosis, PBL in an extraoral site is difficult to suspect clinically in a patient who is HIV negative. The small intestine as a site of PBL has also been described very rarely. We herein present a rare case of PBL of the small intestine in an 85-year-old HIV- and EBV-negative male.
Collapse
Affiliation(s)
- Yuka Fukuo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | | | - Karin Ashizawa
- Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Japan
| | - Kentaro Ito
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | - Michio Saeki
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | | | - Masahito Takahashi
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | - Kei Nomura
- Department of Gastroenterology, Juntendo University, Japan
| | - Koki Okahara
- Department of Gastroenterology, Juntendo University, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University, Japan
| | - Kanako Ogura
- Department of Diagnostic Pathology, Juntendo University Nerima Hospital, Japan
| | - Hironao Okubo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Japan
| | | |
Collapse
|
27
|
Johan S, Khairuddin A, Zuki AM, Teng WW, Hayati F, Mra A, Azizan N. Malignant ulcer: a great mimicker of gastric plasmablastic lymphoma. Clin J Gastroenterol 2021; 14:1027-1030. [PMID: 33797037 DOI: 10.1007/s12328-021-01409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 03/27/2021] [Indexed: 11/28/2022]
Abstract
Plasmablastic lymphoma (PBL) is an uncommon human immunodeficiency virus (HIV)-associated lymphoma, with a predilection to develop in the oral cavity. It usually has a plasmablastic morphology with weak or no expression of B cell-associated markers. Among non-HIV patients, it tends to occur in the gastrointestinal (GI) tract, lymph nodes, and skin. We experience a 74-year-old male who presented with abdominal discomfort, altered bowel habit, loss of weight, and loss of appetite with a palpable abdominal mass. Upper endoscopy revealed multiple dish-like and raised nodular mass with a central ulcer in the stomach and duodenum. The histology was consistent with high-grade lymphoma of the plasmablastic type. The immunohistochemistry was positive for plasma cells marker of CD38 and CD138, but negative for the lymphocytic marker of CD45, as well as mature T and B cell marker of CD3 and CD20. Unfortunately, the patient succumbed due to sepsis without completion of his investigations and treatments.
Collapse
Affiliation(s)
- Syamim Johan
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Allim Khairuddin
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Asyraf Mohd Zuki
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Wei Woon Teng
- Department of Surgery, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
| | - Aung Mra
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Nornazirah Azizan
- Department of Pathobiology and Medical Diagnostic, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| |
Collapse
|
28
|
Rong C, Sheng L, Wu A, Sun Y, Ouyang G. Allogeneic hematopoietic stem cell transplantation in a patient with HIV-negative recurrent plasmablastic lymphoma: A case report. Medicine (Baltimore) 2021; 100:e24498. [PMID: 33607779 PMCID: PMC7899902 DOI: 10.1097/md.0000000000024498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/21/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION No standard guideline has been established for the treatment of plasmablastic lymphoma (PBL) and prognosis remains extremely poor, given that patients relapse early after chemotherapy and show resistance to commonly used cytostatic drugs. PATIENT CONCERNS We present the case of a 52-year-old HIV-negative man who presented with a mass at the left sternoclavicular joint. He had no significant comorbidities and no latent immunosuppression. DIAGNOSIS The largest lymph node measured was 36 × 19 mm. An excisional biopsy showed diffuse proliferation of large lymphoid cells which were positive for CD38 and CD138, but negative for CD20. He was diagnosed with stage IV PBL with a low IPI. INTERVENTIONS The patient was treated with four cycles of induction therapy with bortezomib, epirubicin and dexamethasone. He achieved complete remission. But 3 months after receiving consolidated autologous hematopoietic stem cell transplantation, he relapsed. Allogeneic hematopoietic stem cell transplantation was performed on the patient. OUTCOMES The patient achieved remission again and there were no serious complications after allogeneic hematopoietic stem cell transplantation. This patient was followed up once every three months, and to date, he has been disease-free for more than 4 years. CONCLUSION The survival of recurrent PBL after autologous hematopoietic stem cell transplantation is very poor. Salvage allogeneic hematopoietic stem cell transplantation may bring long-term survival opportunities for those patients. Further clinical studies are needed to explore the role of allogeneic hematopoietic stem cell transplantation in refractory and recurrent PBL.
Collapse
Affiliation(s)
| | - Lixia Sheng
- Ningbo First Hospital, Zhejiang, People's Republic of China
| | - An Wu
- Medical School of Ningbo University
| | - Ye Sun
- Medical School of Ningbo University
| | - Guifang Ouyang
- Ningbo First Hospital, Zhejiang, People's Republic of China
| |
Collapse
|
29
|
Sapkota S, Priyadarshini M, Hazarika D, Swamy S, Naik R. Plasmablastic Lymphoma Involving Kidney in an HIV Positive Patient: A Case Report with Review of the Literature. Indian J Nephrol 2021; 31:176-178. [PMID: 34267442 PMCID: PMC8240923 DOI: 10.4103/ijn.ijn_277_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/12/2019] [Accepted: 04/01/2020] [Indexed: 11/24/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive lymphoma commonly associated with HIV infection. It most commonly presents in the oral cavity and rarely involves the kidney. Herein, we report a case of HIV positive male with renal involvement of PBL. The patient presented with unilateral severe hydronephrosis with unaltered renal functions. Despite aggressive management, there was an early relapse and the patient died within 2 years of the diagnosis. Despite the recent advances in the therapy of HIV-associated aggressive lymphomas, patients with PBL have a poor prognosis. Multimodal treatment with chemotherapy, newer targeted and biological agents, along with hematopoietic stem cell transplantation is essential for the treatment of PBL.
Collapse
Affiliation(s)
- Sulav Sapkota
- Department of Hematology and Medical Oncology, HCG Hospital, Bengaluru, Karnataka, India
| | | | - Diganta Hazarika
- Department of Pathology, HCG Hospital, Bengaluru, Karnataka, India
| | - Shivakumar Swamy
- Department of Radiology, HCG Hospital, Bengaluru, Karnataka, India
| | - Radheshyam Naik
- Department of Hematology and Medical Oncology, HCG Hospital, Bengaluru, Karnataka, India
| |
Collapse
|
30
|
Kathrotiya M, Radhakrishnan VS, Bhave SJ, Kumar J, Roychowdhury M, Arun I, Das J, Chandy M, Nair R. Relapsed plasmablastic lymphoma in a HIV-negative patient: Pushing the envelope. Clin Case Rep 2021; 9:873-877. [PMID: 33598263 PMCID: PMC7869339 DOI: 10.1002/ccr3.3673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 11/22/2022] Open
Abstract
This case emphasizes that, with the availability of novel immunotherapy agents (Daratumumab), and repurposed use of bortezomib, a patient with HIV-negative relapsed PBL can be treated successfully and consolidated with an allogeneic haploidentical hematopoietic cell transplantation.
Collapse
Affiliation(s)
| | | | - Saurabh J Bhave
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Jeevan Kumar
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Mita Roychowdhury
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Indu Arun
- PathologyTata Medical CenterKolkataIndia
| | - Jayanta Das
- Nuclear MedicineTata Medical CenterKolkataIndia
| | - Mammen Chandy
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Reena Nair
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| |
Collapse
|
31
|
Makady NF, Ramzy D, Ghaly R, Abdel-Malek RR, Shohdy KS. The Emerging Treatment Options of Plasmablastic Lymphoma: Analysis of 173 Individual Patient Outcomes. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 21:e255-e263. [PMID: 33419717 DOI: 10.1016/j.clml.2020.11.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/18/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022]
Abstract
Plasmablastic lymphoma (PBL) is a newly recognized aggressive subtype of non-Hodgkin lymphoma. Its rarity hinders testing effective treatment options in clinical trials. We conducted a systematic review of PubMed and our internal records to retrieve patients with a PBL diagnosis with evaluable treatment outcomes. Aggressive chemotherapy was defined as more intense regimens than CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). We compiled a meta-dataset of 173 patients. The median age at diagnosis was 48.5 years, 75% of patients were male, and stages III/IV accounted for 47% of the cohort. Of 138 patients with known response status after first-line chemotherapy, 63 (45%) achieved a complete response with a 2-year relapse-free survival of 71.6%. Sixty-nine (50%) patients received first-line CHOP. There was no significant difference in the objective response rate among the 2 most commonly used regimens, CHOP and DA-EPOCH (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) (69% vs. 79%; P = .4). The median follow-up was 9 months, and the 2-year overall survival (OS) was 47.4%. A univariate analysis identified factors associated with worse OS, including stage III/IV (hazard ratio [HR], 2.82; P < .001), human herpes virus-8-positive (HR, 3.30; P = .01), bone marrow (HR, 1.07; P = .035), and cardiorespiratory involvement (HR, 2.26; P = .015). Meanwhile, Epstein-Varr virus-encoded small RNA-positivity (HR, 0.31; P < .001) and involvement of head and neck (HR, 0.44; P = .009) were associated with better OS. Multivariate analysis showed that aggressive chemotherapy was significantly associated with better OS (HR, 0.22; P = .016). Patients with PBL with high-risk features, such as advanced stage, human herpes virus-8-positivity, bone marrow, and cardiorespiratory involvement, require more aggressive chemotherapy. Bortezomib and lenalidomide are promising add-on agents.
Collapse
Affiliation(s)
- Nafie F Makady
- Department of Clinical Oncology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
| | - David Ramzy
- Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ramy Ghaly
- Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Raafat R Abdel-Malek
- Department of Clinical Oncology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Kyrillus S Shohdy
- Department of Clinical Oncology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY
| |
Collapse
|
32
|
Florindez JA, Alderuccio JP, Reis IM, Lossos IS. Survival analysis in treated plasmablastic lymphoma patients: a population-based study. Am J Hematol 2020; 95:1344-1351. [PMID: 32777103 DOI: 10.1002/ajh.25955] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/19/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jorge A. Florindez
- Division of Hospital Medicine, Miller School of Medicine University of Miami Miami Florida
| | - Juan P. Alderuccio
- Divison of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
| | - Isildinha M. Reis
- Department of Public Health Science, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
- Biostatistics and Bioinformatics Core Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
| | - Izidore S. Lossos
- Divison of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
- Department of Molecular and Cellular Pharmacology University of Miami Miami Florida
| |
Collapse
|
33
|
Chicuellar NR, Sufyan W, Mahendran S. Unilateral Maxillary Sinus Plasmablastic Lymphoma in an Immunocompetent Patient. An Unusual Occurrence Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 101:NP251-NP255. [PMID: 33044847 DOI: 10.1177/0145561320963715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive form of mature B cell neoplasms almost exclusively identified in patients infected with the human immunodeficiency virus (HIV). The small number of HIV-negative PBL cases reported in the literature to date is composed of single case reports and small case series which characteristically are present involving the oral cavity mucosa or gingiva. We present a 72-year-old HIV-negative Australian patient without any cause of immunodeficiency, with an isolated left maxillary sinus PBL.
Collapse
Affiliation(s)
- Nayellin Reyes Chicuellar
- Department of Otolaryngology, Head and Neck Surgery, Royal Darwin Hospital, Northern Territory, Australia
| | - Wajiha Sufyan
- Department of Anatomical Pathology, Royal Darwin Hospital, Northern Territory, Australia
| | - Suresh Mahendran
- Department of Otolaryngology, Head and Neck Surgery, Royal Darwin Hospital, Northern Territory, Australia
| |
Collapse
|
34
|
Vaughan J, Perner Y, Mayne E, Wiggill T. Plasmablastic lymphoma in Johannesburg, South Africa, in the era of widescale antiretroviral therapy use. HIV Med 2020; 22:225-230. [PMID: 33022825 DOI: 10.1111/hiv.12965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/20/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
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.
Collapse
Affiliation(s)
- J Vaughan
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Molecular Medicine and Haematology, National Health Laboratory Services, Johannesburg, South Africa
| | - Y Perner
- Department of Anatomical Pathology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Anatomical Pathology, National Health Laboratory Services, Johannesburg, South Africa
| | - E Mayne
- Department of Immunology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Immunology, National Health Laboratory Services, Johannesburg, South Africa
| | - T Wiggill
- Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Molecular Medicine and Haematology, National Health Laboratory Services, Johannesburg, South Africa
| |
Collapse
|
35
|
Fu WJ, He MX, Huang AJ, Gao L, Lu GH, Chen J, Chen L, Ni X, Zhang WP, Wang JM, Yang JM. [Clinical characteristics and survival analysis of 15 cases of HIV-negative plasmablastic lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 41:456-461. [PMID: 32654457 PMCID: PMC7378287 DOI: 10.3760/cma.j.issn.0253-2727.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
目的 分析HIV阴性的浆母细胞淋巴瘤(PBL)患者的临床病理特征及转归。 方法 回顾性分析海军军医大学附属长海医院2013年1月至2019年8月诊断及治疗的15例HIV阴性PBL患者的临床病理资料及随访结果。 结果 15例HIV阴性PBL患者中男8例,女7例,中位年龄59(17~69)岁,均无明确的免疫抑制状态。所有患者均出现结外受累,Ann Arbor-Cotswolds分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为1例(6.7%)、2例(13.3%)、3例(20.0%)、9例(60.0%)。病理形态表现为类似免疫母细胞的大肿瘤细胞弥漫性增生,免疫组化示肿瘤细胞主要表达浆细胞标志CD38、CD138、Mum-1,B细胞标志CD20、CD10、PAX-5、BCL-6少见,Ki-67中位数为80%(70%~90%)。3例患者行EBER原位杂交检测,1例阳性。15例患者均接受化疗,80%(12/15)联合硼替佐米作为一线治疗。最佳疗效6例完全缓解(其中2例分别于治疗后4.9和26.1个月疾病进展),2例部分缓解(分别于治疗后3.0和6.8个月疾病进展),4例疾病进展,3例无法评估。中位随访时间30.3(4.8~61.1)个月,11例患者中位无进展生存(PFS)期6.8(95%CI 2.5~11.1)个月,预计3年PFS率为21.2%(95%CI 1.4%~56.8%)。所有患者中位总生存(OS)期为17.9(95%CI 5.6~30.2)个月,预计3年OS率为38.5%(95%CI 12.0%~65.0%)。 结论 HIV阴性PBL侵袭性强,结外受累常见,多数患者诊断时分期较晚。通过以硼替佐米为基础的强化疗方案序贯自体造血干细胞移植可望获得长期生存。
Collapse
Affiliation(s)
- W J Fu
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - M X He
- Department of Pathology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - A J Huang
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - L Gao
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - G H Lu
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - J Chen
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - L Chen
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - X Ni
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - W P Zhang
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - J M Wang
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| | - J M Yang
- Department of Hematology, Institute of Hematology, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai 200433, China
| |
Collapse
|
36
|
Yap DRY, Tan GF, Chang EWY, Yang VS, Poon EYL, Somasundaram N, Farid M, Tang T, Tao M, Lim ST, Chan JY. Clinical Features of Plasmablastic Lymphoma: Case Series From an Asian Tertiary Cancer Center and Literature Review. J Hematol 2020; 9:71-78. [PMID: 32855755 PMCID: PMC7430862 DOI: 10.14740/jh672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Plasmablastic lymphoma (PBL) is an aggressive subtype of mature B-cell non-Hodgkin lymphoma. Given its rarity, there remains a lack of clinicopathological data to guide its management, particularly on Asian patients. Methods We conducted a retrospective chart review of 10 patients diagnosed with PBL at the National Cancer Centre Singapore and performed a literature review of similar studies on Asian cohorts. Results Most patients were male (n = 9), with median age at diagnosis of 55 years (range, 33 - 91 years). Seven (70%) patients were considered to be immunocompromised. In the overall cohort, the median overall survival (OS) was 19.4 months with 5-year survival estimates given at 60% and 36% for OS and progression-free survival (PFS), respectively. At diagnosis, patients with HIV/AIDS (n = 5) were younger compared to others (median, 43 vs. 61 years; P = 0.0278), had greater number of nodal site involvement (median, 6 vs. 0; P = 0.0333), and higher international prognostic index (IPI) scores (P = 0.034 for trend). Amongst different chemotherapy used, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin (EPOCH)-based regimens (n = 6) elicited prominent complete response rates (83%) and led to durable responses even in the setting of advanced stage, high-risk IPI score and immunodeficiency. Conclusions In conclusion, our study describes the features of PBL in an Asian cohort and highlights disease features unique to HIV-associated PBL.
Collapse
Affiliation(s)
- Daniel Ren Yi Yap
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Grace Fangmin Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Esther Wei Yin Chang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Eileen Yi Ling Poon
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Nagavalli Somasundaram
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tiffany Tang
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Miriam Tao
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| |
Collapse
|
37
|
Epidemiology of haematological malignancies in people living with HIV. Lancet HIV 2020; 7:e641-e651. [PMID: 32791045 DOI: 10.1016/s2352-3018(20)30118-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022]
Abstract
People living with HIV or AIDS are at increased risk of Hodgkin and non-Hodgkin lymphoma compared with HIV-negative individuals. Data on the risk of multiple myeloma or leukaemia are inconsistent and of low quality but the risk does not seem to be increased. Specific haematological malignancies occur in different contexts of age, CD4 cell count, HIV control, viral co-infections, or chronic inflammation, and the expansion of combination antiretroviral therapy has led to varied demographic and epidemiological shifts among people with HIV. Increased use of combination antiretroviral therapy has substantially reduced the risks of diffuse large B-cell lymphoma, Burkitt lymphoma, and primary CNS lymphoma, and to a lesser extent, Hodgkin lymphoma. There is no effect of combination antiretroviral therapy use on multiple myeloma or leukaemia. Although many cases of HIV are in low-income and middle-income countries, high-quality epidemiological data for haematological malignancies from these regions are scarce. Closing this gap is an essential first step in decreasing mortality from HIV-associated haematological malignancies worldwide. Finally, although multicentric Castleman disease is not a neoplastic condition, it is an emerging precursor to neoplastic high-grade B-cell lymphoproliferation among people with HIV, especially for individuals on long-term combination antiretroviral therapy with well controlled HIV.
Collapse
|
38
|
Al Sbihi AF, Singh P, Manasrah N, Kandah E, Appel J. An HIV Associated Plasmablastic Lymphoma With Spontaneous Tumor Lysis Syndrome. Cureus 2020; 12:e9625. [PMID: 32923226 PMCID: PMC7478934 DOI: 10.7759/cureus.9625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell Non-Hodgkin lymphoma (NHL) associated with immunocompromised states such as HIV. We present a case of PBL in an HIV patient presenting as spontaneous tumor lysis syndrome and discuss the clinical challenges hence encountered.
Collapse
Affiliation(s)
- Ali F Al Sbihi
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
| | - Paramveer Singh
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
| | - Emad Kandah
- Internal Medicine, McLaren Flint, Flint, USA
| | - Joel Appel
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
| |
Collapse
|
39
|
Mwazha A, Nhlonzi GB, Mazengenya P. Gastrointestinal Tract Plasmablastic Lymphoma in HIV-Infected Adults: A Histopathological Review. Int J Surg Pathol 2020; 28:735-748. [PMID: 32552168 DOI: 10.1177/1066896920932272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND. Plasmablastic lymphoma (PBL) is an aggressive B-cell lymphoma that is characterized by the expression of plasma cell antigens and loss of pan B-cell antigens. The neoplasm is extensively reported in the oral cavity and anorectal region but rarely in the gastrointestinal tract, where only isolated case reports and small case series have been reported. In the current study, morphologic, immunohistochemical, and molecular features of 17 cases of gastrointestinal tract PBL were reviewed. METHODS. Ten-year retrospective study that reappraised the histomorphological and immunophenotypical profiles of HIV-associated PBLs in the gastrointestinal tract. RESULTS. The mean age of the study patients was 41 years with a 3:1 ratio of males to females. The most common site of tumor origin was the small intestine (42%), followed by the stomach (29%) and the colon (29%). Majority of the cases showed a predominant diffuse (82%) growth pattern. Immunoblasts and plasmablasts were observed in all cases. Plasmacytic differentiation was seen in 5 (29%) cases. Additional observations not previously described or emphasized in literature includes pseudo-alveolar growth pattern, centroblast-predominance, multinucleated giant cells, and clear cell change. Immunohistochemistry revealed absence of pan B-cell antigens and expression of plasma cell antigens in all cases. Epstein-Barr virus-encoded RNA was expressed in 53% of the cases. CONCLUSIONS. This study highlights the spectrum of histopathological features seen in gastrointestinal tract PBLs. Awareness of this entity and its histopathological features in the gastrointestinal tract is essential for making a timely and accurate diagnosis and improving patient outcomes.
Collapse
Affiliation(s)
- Absalom Mwazha
- University of KwaZulu-Natal, Durban, South Africa.,National Health Laboratory Services, Durban, South Africa
| | | | - Pedzisai Mazengenya
- University of the Witwatersrand, Johannesburg, South Africa.,Ajman University, Ajman, United Arab Emirates
| |
Collapse
|
40
|
Rosado F, Guo L, Fuda F. Hematolymphoid neoplasms with a plasma cell phenotype. Semin Diagn Pathol 2020; 37:268-272. [PMID: 32564903 DOI: 10.1053/j.semdp.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | - Ling Guo
- Ohio State University Wexner Medical Center
| | | |
Collapse
|
41
|
Clinical, pathological and molecular features of plasmablastic lymphoma arising in the gastrointestinal tract: A review and reappraisal. Pathol Res Pract 2020; 216:152973. [PMID: 32370987 DOI: 10.1016/j.prp.2020.152973] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
Plasmablastic lymphoma (PBL) is a CD20-negative large B-cell lymphoma with a plasmacytic phenotype and a dismal prognosis, which has been defined as a distinct entity only in the 2008 WHO Classification of Haematopoietic and Lymphoid Tissue and confirmed in the 2017 Edition. Current knowledge of the biological, clinical and prognostic features of PBL is mostly limited, resulting in diagnostic issues, as well as in lack of standard of care and effective therapeutic options. PBL commonly affects the oral cavity of HIV-positive individuals, however the gastrointestinal (GI) tract is the most common extraoral site, and in this location most patients are HIV-negative. In this review, we focus on the clinical, morphological and prognostic features of PBL arising in the GI tract, in order to improve knowledge on this rare, but aggressive disease.
Collapse
|
42
|
Li YJ, Li JW, Chen KL, Li J, Zhong MZ, Liu XL, Yi PY, Zhou H. HIV-negative plasmablastic lymphoma: report of 8 cases and a comprehensive review of 394 published cases. Blood Res 2020; 55:49-56. [PMID: 32269975 PMCID: PMC7106118 DOI: 10.5045/br.2020.55.1.49] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/06/2020] [Accepted: 03/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-negative plasmablastic lymphoma (PBL) is a rare entity of diffuse large B-cell lymphoma (DLBCL). The clinicopathological features of and optimal treatment for HIV-negative PBL remain largely unknown. Methods To gain insight into this distinct lymphoma, we summarized the clinicopathologic characteristics of 8 unpublished HIV-negative PBLs and performed a comprehensive review of 394 published cases. Results Of the 8 unpublished PBLs, the median patient age was 53.0 years. Four patients presented with stage IV disease. All 8 patients showed a plasma cell-like immunophenotype. Of the six patients who received anthracycline-based chemotherapy, including two who received bortezomib, three patients achieved a continuous complete response, two patients died due to disease progression, and one patient was lost to follow-up. The other two patients achieved continuous complete response after receiving chemotherapy combined with radiotherapy and surgery. Of the 402 patients, the majority were male, with a mean age of 58.0 years. EBV infection was detected in 55.7% of the patients. The median survival times of the patients who received CHOP or CHOP-like regimens and intensive regimens were not reached and 23.0 months, respectively, and the intensive regimen did not improve the survival outcome (P=0.981). Multivariate analysis showed that EBER remained the only independent factor affecting overall survival (OS). Conclusion HIV-negative PBL is a distinct entity with a predilection for elderly and immunosuppressed individuals. Intensive chemotherapy had no apparent survival benefits over the CHOP regimen in terms of OS; the prognosis of this disease is poor with current chemotherapy methods, and treatment remains a challenge.
Collapse
Affiliation(s)
- Ya-Jun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, China.,Department of Lymphoma and Hematology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ji-Wei Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Institute of Pathology, Fudan University, Shanghai, China
| | - Kai-Lin Chen
- Department of Lymphoma and Hematology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China.,Department of Radiotherapy, Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, Changsha, China
| | - Jin Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, China.,Department of Lymphoma and Hematology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Mei-Zuo Zhong
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Xian-Ling Liu
- Department of Oncology, Cancer Center of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping-Yong Yi
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, China.,Department of Lymphoma and Hematology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Hui Zhou
- Department of Lymphoma and Hematology, Hunan Cancer Hospital, Changsha, China.,Department of Lymphoma and Hematology, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| |
Collapse
|
43
|
Shakri NM, Husain S, Zahedi FD, Tan GC. Nasal Plasmablastic Lymphoma in an HIV-Negative Immunocompetent Patient. Medeni Med J 2020; 35:71-74. [PMID: 32733753 PMCID: PMC7384497 DOI: 10.5222/mmj.2020.45389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/06/2020] [Indexed: 11/05/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B-cell lymphoma predominantly in oral cavities of human immunodeficiency virus (HIV)-positive male patients or immunosuppressive hosts. Limited number of reports on HIV-negative PBL in immunocompetent patients are available in the literature. We reported an unusual case of sinonasal PBL which occurred in an HIV-negative and immunocompetent female patient. She underwent endoscopic removal of the tumor and completed 6 cycles of chemotherapy (hyperfractionated-CVAD). Any finding in favour of tumour recurrence was not observed in positron-emission tomography scan (PET-scan) performed 18 months after the treatment.
Collapse
Affiliation(s)
- Nadhirah Mohd Shakri
- Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology - Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Salina Husain
- Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology - Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Farah Dayana Zahedi
- Universiti Kebangsaan Malaysia Medical Centre, Department of Otorhinolaryngology - Head and Neck Surgery, Kuala Lumpur, Malaysia
| | - Geok Chin Tan
- Universiti Kebangsaan Malaysia Medical Centre, Department of Pathology, Kuala Lumpur, Malaysia
| |
Collapse
|
44
|
Goldstein JS, Switchenko JM, Behera M, Flowers CR, Koff JL. Insurance status impacts overall survival in Burkitt lymphoma. Leuk Lymphoma 2019; 60:3225-3234. [PMID: 31274033 PMCID: PMC6923579 DOI: 10.1080/10428194.2019.1623884] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/16/2019] [Accepted: 05/15/2019] [Indexed: 12/11/2022]
Abstract
The impact of insurance status on clinical outcomes in Burkitt (BL) and plasmablastic (PBL) lymphomas remains unknown. We used the National Cancer Database to examine insurance status' effect on overall survival (OS) in adults diagnosed with these lymphomas between 2004 and 2014. BL patients with private insurance had significantly better OS compared to those without. In patients aged <65 years, hazard ratios were 1.4 for uninsured status (95% confidence interval 1.2-1.7), 1.2 for Medicaid (95% CI 1.0-1.4), and 1.5 for Medicare (95% CI 1.2-1.9). For patients aged >65 years, hazard ratio for uninsured status was 8.4 (95% CI 2.5-28.3). Conversely, underinsured PBL patients experienced no difference in OS. Thus, expanding insurance-related access to care may improve survival in BL, for which curative therapy exists, but not PBL, where more effective therapies are needed. Our findings add to mounting evidence that adequate health insurance is particularly important for patients with curable cancers.
Collapse
Affiliation(s)
| | - Jeffrey M. Switchenko
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Madhusmita Behera
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Christopher R. Flowers
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Jean L. Koff
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA
| |
Collapse
|
45
|
Bhattacharyya S, Bains AP, Sykes DL, Iverson BR, Sibgatullah R, Kuklani RM. Lymphoid neoplasms of the oral cavity with plasmablastic morphology—a case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:651-659. [DOI: 10.1016/j.oooo.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/27/2019] [Accepted: 08/01/2019] [Indexed: 01/27/2023]
|
46
|
Plasmablastic Lymphoma, a Rare Entity in Bone Marrow with Unusual Immunophenotype and Challenging Differential Diagnosis. Case Rep Hematol 2019; 2019:1586328. [PMID: 31565447 PMCID: PMC6745100 DOI: 10.1155/2019/1586328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 01/22/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive malignancy that usually occurs in the setting of immunosuppression. The immunohistochemical profile of PBL is that of terminally differentiated B lymphocytes. CD138, CD38, and MUM1 are usually immunopositive. However, pan B-cell markers such as CD20 and PAX-5 are usually negative. MYC rearrangement is the most commonly encountered genetic alteration, with immunoglobulin (IG), especially immunoglobulin heavy (IGH) chain, being the most frequent partner. We report a case of PBL in a 48-year-old human immunodeficiency virus- (HIV-) positive male who was admitted to the hospital with signs and symptoms suspicious for tumor lysis syndrome. Bone marrow examination revealed hypercellular marrow with trilineage hypoplasia and sheets of intermediate to large neoplastic cells with basophilic vacuolated cytoplasm comprising the majority of cellular elements of the bone marrow. The neoplastic cells were negative for conventional B-cell, T-cell, plasma cell, and myeloid markers, while flow cytometric analysis revealed an abnormal CD45-dim population that was partially weakly positive for CD71 and CD79b. The diagnosis was initially thought to be a high-grade primitive hematopoietic neoplasm, possibly an acute undifferentiated leukemia. BOB-1, however, was immunopositive in the neoplastic cells, confirming its B-cell origin. MYC was positive by immunohistochemistry and break-apart FISH, as were CD45, MUM-1, and EMA immunostains. There was immunoglobulin kappa (IGK) light chain gene rearrangement by polymerase chain reaction (PCR). Additionally, Epstein–Barr virus- (EBV–) encoded small RNAs (EBER) were positive by in situ hybridization (ISH). The tumor proliferation index by Ki-67 immunostaining approached 95%. Although the tumor cells were negative for CD38 and CD138, the diagnosis of PBL was still rendered. We recommend using a broad spectrum of B-cell markers, including BOB-1 and OCT-2, in such challenging cases of B-cell lymphomas with no expression of conventional B-cell markers. We also emphasize that the negative CD38 and CD138 should not exclude PBL from the differential diagnosis.
Collapse
|
47
|
Perkins JN, Chi AW, Patel NJ. Plasmablastic Lymphoma of the Nasal Septum. JAMA Otolaryngol Head Neck Surg 2019; 145:868-869. [PMID: 31318382 DOI: 10.1001/jamaoto.2019.1719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jonathan N Perkins
- Department of Otolaryngology-Head & Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Kaiser Permanente-Mid Atlantic Permanente Group, Falls Church, Virginia
| | - Anthony W Chi
- Department of Pathology, Kaiser Permanente Mid Atlantic, Regional Laboratory, Rockville, Maryland
| | - Nitinkumar J Patel
- Department of Otolaryngology-Head & Neck Surgery, Kaiser Permanente-Mid Atlantic Permanente Group, Falls Church, Virginia
| |
Collapse
|
48
|
A case of intraoral plasmablastic lymphoma spontaneously regressed after biopsy in HIV-negative patient. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2019. [DOI: 10.1016/j.ajoms.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
49
|
Damlaj M, Alzayed M, Alahmari B, Alhejazi A, Alaskar A, Alzahrani M. Therapeutic Potential of Checkpoint Inhibitors in Refractory Plasmablastic Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e559-e563. [PMID: 31377210 DOI: 10.1016/j.clml.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Moussab Damlaj
- Division of Hematology and HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed Alzayed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; Division of Molecular Imaging and Nuclear Medicine, Department of Medical Imaging, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Bader Alahmari
- Division of Hematology and HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ayman Alhejazi
- Division of Hematology and HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ahmed Alaskar
- Division of Hematology and HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Mohsen Alzahrani
- Division of Hematology and HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
50
|
Rhoades R, Gong J, Palmisiano N, Alpdogan O. Primary central nervous system plasmablastic lymphoma in an HIV-positive patient. BMJ Case Rep 2019; 12:12/3/e226755. [PMID: 30872336 DOI: 10.1136/bcr-2018-226755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare subtype of diffuse large B-cell lymphoma, highly associated with HIV and Epstein-Barr virus (EBV) infections. It commonly presents in extranodal sites, often an oral mass, but reports of primary central nervous system PBL (PCNSPBL) are exceedingly rare. Here, we report on a 33-year-old man with newly diagnosed HIV infection who presented with acute-onset unilateral visual disturbance and was found to have biopsy-proven PCNSPBL. The neoplastic cells displayed a plasmacytoid appearance, with the expression of CD38 and CD138, and were positive for EBV by in situ hybridisation for EBV-encoded RNA. Systemic workup revealed the presence of Kaposi sarcoma, but no evidence of lymphoma. He is currently being treated with high-dose methotrexate, as well as antiretroviral therapy for his HIV infection, and has achieved a complete response.
Collapse
Affiliation(s)
- Ruben Rhoades
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jerald Gong
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Neil Palmisiano
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Onder Alpdogan
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|