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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.
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Affiliation(s)
- Supreet Kaur
- University of Texas Health Science Center San Antonio, TX.
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2
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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.
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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
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Tchernonog E, Faurie P, Coppo P, Monjanel H, Bonnet A, Algarte Génin M, Mercier M, Dupuis J, Bijou F, Herbaux C, Delmer A, Fabiani B, Besson C, Le Gouill S, Gyan E, Laurent C, Ghesquieres H, Cartron G. Clinical characteristics and prognostic factors of plasmablastic lymphoma patients: analysis of 135 patients from the LYSA group. Ann Oncol 2017; 28:843-848. [PMID: 28031174 DOI: 10.1093/annonc/mdw684] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Indexed: 11/14/2022] Open
Abstract
Background Plasmablastic lymphoma (PBL), initially described in 1997 in the oral cavity of HIV positive patients, is now recognized as a distinct aggressive and rare entity of diffuse large B-cells lymphoma by the World Health Organization (WHO) classification. Since the original description, others cases have been reported. However, these are largely derived from case reports or small series limiting any definitive conclusions on clinical characteristics and outcome. Patients and methods The clinical, biological, pathological features and outcome of a cohort including 135 patients with PBL, from LYSA centers in France and Belgium, were reported and analyzed. Results The median age was 58 years, with a male predominance. The cohort was divided into 56 HIV-positive patients, 17 post-transplant patients and 62 HIV-negative/non-transplanted patients. Within HIV-negative/non-transplanted, a relative immunosuppression was found in most cases (systemic inflammatory disease, history of cancer, increased age associated with weakened immune system). We have also described a new subtype, PBL arising in a chronic localized inflammatory site, without any sign of immunosuppression. At presentation, 19% of patients showed oral involvement. Immunophenotype showed CD138 positivity in 88% of cases and CD20 negativity in 90% of cases. Chemotherapy was administered to 80% of patients, with a complete response (CR) rate of 55%. The median overall survival (OS) was 32 months. In univariate analysis, HIV positive status showed better OS when compared with HIV negative status. In multivariate analysis, International Prognostic Index score, chemotherapy and CR were associated with survival benefit. Conclusion(s) This cohort, the largest reported to date, increases the spectrum of knowledge on PBL, rarely described. However, specific guidelines to clarify treatment are lacking, and may improve the poor prognosis of this rare disease.
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Affiliation(s)
- E Tchernonog
- Department of Hematology, University Hospital of Montpellier, Montpellier, France
| | - P Faurie
- Department of Hematology, Léon Bérard Center, Lyon, France
| | - P Coppo
- Department of Hematology, Saint Antoine University Hospital, Paris, France
| | - H Monjanel
- Department of Hematology, University Hospital of Tours, Tours, France
| | - A Bonnet
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - M Algarte Génin
- Institute Pierre Louis of Epidemiology and Public Health, Paris, France
| | - M Mercier
- Department of Hematology, University Hospital of Angers, Angers, France
| | - J Dupuis
- Lymphoid Malignancies Unit University Hospital Henri Mondor, Créteil, France
| | - F Bijou
- Institute Bergonie, Bordeaux, France
| | - C Herbaux
- Department of Hematology, University Hospital of Lille, Lille, France
| | - A Delmer
- Department of Hematology, University Hospital of Reims, Reims, France
| | - B Fabiani
- Department of Biopathology, University Hospital Saint Antoine, Paris, France
| | - C Besson
- Department of Hematology, University Hospital Kremlin Bicêtre, Paris, France
| | - S Le Gouill
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - E Gyan
- Department of Hematology, University Hospital of Tours, Tours, France
| | - C Laurent
- Department of Biopathology, University Hospital of Toulouse, Toulouse, France
| | - H Ghesquieres
- Department of Hematology, University Hospital of Lyon Sud, Lyon, France, France
| | - G Cartron
- Department of Hematology, University Hospital of Montpellier, Montpellier, France
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Fernández-Álvarez R, Sancho JM, Ribera JM. [Plasmablastic lymphoma]. Med Clin (Barc) 2016; 147:399-404. [PMID: 27576534 DOI: 10.1016/j.medcli.2016.06.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 02/01/2023]
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive subtype of non-Hodgkin lymphoma that commonly occurs in human immunodeficiency virus (HIV)-positive individuals, and affects oral sites. Occasionally, it has been described in HIV-negative patients and involving non-oral sites. Pathologically, PBL is a high-grade B-cell lymphoma that displays the immunophenotype of a terminally differentiated B-lymphocyte with loss of B-cell markers (CD20) and expression of plasma-cell antigens. Epstein-Barr virus infection and MYC rearrangements are frequently observed. Treatment of PBL is challenging because of the lack of established treatment and poor outcomes, with median survival times shorter than one year. In this review, we discuss the clinical and epidemiologic spectrum of PBL as well as its distinct pathological features. Finally, we summarize the currently available approaches for the treatment of patients with PBL.
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Affiliation(s)
| | - Juan-Manuel Sancho
- Servicio de Hematología Clínica, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - Josep-María Ribera
- Servicio de Hematología Clínica, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Institut de Recerca contra la Leucèmia Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
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Bibas M, Castillo JJ. Current knowledge on HIV-associated Plasmablastic Lymphoma. Mediterr J Hematol Infect Dis 2014; 6:e2014064. [PMID: 25408850 PMCID: PMC4235470 DOI: 10.4084/mjhid.2014.064] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/21/2014] [Indexed: 12/19/2022] Open
Abstract
HIV-associated PBL is an AIDS-defining cancer, classified by WHO as a distinct entity of aggressive DLBCL. To date less than 250 cases have been published, of them 17 are pediatric. The pathogenesis of this rare disease is related to immunodeficiency, chronic immune stimulation and EBV. Clinically is a rapid growing destructive disease mainly involving the oral cavity even if extraoral and extranodal sites are not infrequent. The diagnosis requires tissue mass or lymph node biopsy and core needle or fine needle biopsy is acceptable only for difficult access sites. Classically immunophenotype is CD45, CD20, CD79a negative and CD38, CD138, MUM1 positive, EBER and KI67 is >80%. Regarding the therapy, standard treatment is, usually, CHOP or CHOP-like regimens while more intensive regimens as CODOX-M/IVAC or DA-EPOCH are possible options. Use of cART is recommended during chemotherapy, keeping in mind the possible overlapping toxicities. Rituximab is not useful for this CD20 negative disease and CNS prophylaxis is mandatory. Intensification with ABMT in CR1 may be considered for fit patients. For refractory/relapsed patients, therapy is, usually, considered palliative, however, in chemo-sensitive disease, intensification + ABMT or new drugs as Bortezomib may be considered. Factors affecting outcome are achieving complete remission, PS, clinical stage, MYC, IPI score. Reported median PFS ranges between 6-7 months and median OS ranges between 11-13 months. Long term survivors are reported but mostly in pediatric patients. Finally, due to the scarcity of data on this subtype of NHL we suggest that the diagnosis and the management of HIV-positive PBL patients should be performed in specialized centers.
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Affiliation(s)
- Michele Bibas
- Clinical Department, Hematology, National Institute for Infectious Diseases “Lazzaro Spallanzani” Rome, Italy
| | - Jorge J. Castillo
- Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Harvard medical School, Boston, USA
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Vaubell JI, Sing Y, Ramburan A, Sewram V, Thejpal R, Rapiti N, Ramdial PK. Pediatric plasmablastic lymphoma: a clinicopathologic study. Int J Surg Pathol 2014; 22:607-16. [PMID: 24771257 DOI: 10.1177/1066896914531815] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Plasmablastic lymphoma (PBL) is reported rarely in children. To date, 10 cases are documented in the English-language literature. This study, based on 13 biopsies from 11 HIV-positive children (9 males, 2 females), documents the clinicopathologic features of PBL. The CD4 count ranged from 9 to 800 cells/mm(3). All biopsies demonstrated exclusive plasmablastic morphology; CD20 immunonegativity; and VS38c, EMA, CD31, MUM-1, CD45, and CD79a immunopositivity. B-cell monoclonality was confirmed in all biopsies. Of 3 biopsies subjected to FISH investigation, 2 had a t(8,14) translocation. Nine patients with follow-up details were treated exclusively with HAART (highly active antiretroviral therapy) or with combinations of HAART, chemotherapy, and radiotherapy. Seven patients died. PBL histomorphology, disease stage, and treatment modalities employed were not predictive of outcome. The survival of 2 stage 4 patients for 3 and 8 years each, managed on HAART, chemotherapy, and radiotherapy, however, may justify a role for combined therapeutic modalities for PBL.
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Affiliation(s)
- Jalaludin I Vaubell
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Yetish Sing
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Amsha Ramburan
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Vikash Sewram
- Oncology Research Unit, Medical Research Council, Durban, South Africa
| | - Rajendra Thejpal
- Department of Paediatrics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Nadine Rapiti
- Department of Haematology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
| | - Pratistadevi K Ramdial
- Department of Anatomical Pathology, School of Laboratory Medicine and Medical Sciences, and National Health Laboratory Service, Durban, KwaZulu-Natal, South Africa
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Saraceni C, Agostino N, Cornfield DB, Gupta R. Plasmablastic lymphoma of the maxillary sinus in an HIV-negative patient: a case report and literature review. SPRINGERPLUS 2013; 2:142. [PMID: 23667804 PMCID: PMC3647105 DOI: 10.1186/2193-1801-2-142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/21/2013] [Indexed: 12/18/2022]
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B cell lymphoma. The prognosis of PBL patients is poor. The majority of patients succumb to a fulminant disease course, with most dying in the first year after diagnosis. The small number of HIV-negative PBL cases reported in the literature to date is composed of single case reports and small case series. Consequently, the natural history of the disease in HIV-negative individuals and the optimum treatment are not well characterized. Intensive induction chemotherapy has been associated with marked improved overall survival. However the optimal regimen has not been defined. We describe the third case of PBL of the maxillary sinus which occurred in a 24-year old HIV-negative man. We outline the clinicopathological features and report success using a hyper-CVAD regimen with 6 cycles and consolidation radiation therapy yielding a complete remission of four years.
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Affiliation(s)
- Christine Saraceni
- Department of Internal Medicine, Lehigh Valley Health Network, 1255 S Cedar Crest Blvd Suite 3200, Allentown, PA 18104 USA
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Goto H, Hagiwara S, Hirai R, Miyama T, Honda H, Tagashira A, Iizuka T, Mochizuki M, Teruya K, Kikuchi Y, Oka S, Miwa A. Case of relapsed AIDS-related plasmablastic lymphoma treated with autologous stem cell transplantation and highly active antiretroviral therapy. Rare Tumors 2011; 3:e11. [PMID: 21464873 PMCID: PMC3070448 DOI: 10.4081/rt.2011.e11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/14/2011] [Accepted: 02/21/2011] [Indexed: 11/22/2022] Open
Abstract
Plasmablastic lymphoma is a rare and aggressive malignancy strongly associated with HIV infection. The refractory/relapsed disease rate is high, and the survival rate is characteristically poor. There are no satisfactory salvage regimens for relapsed cases. We successfully performed autologous stem cell transplantation using a regimen consisting of MCNU (ranimustine), etoposide, cytarabine, and melphalan in a Japanese patient with relapsed AIDS-related plasmablastic lymphoma of the oral cavity. Highly active antiretroviral therapy continued during the therapy. Therapy-related toxicity was tolerable, and a total of 40 Gy of irradiation was administered after autologous stem cell transplantation. The patient has remained in complete remission for 16 months since transplantation.
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Affiliation(s)
- Hiroki Goto
- Division of Hematology, Internal Medicine, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo
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Bibas M, Grisetti S, Alba L, Picchi G, Del Nonno F, Antinori A. Patient With HIV-Associated Plasmablastic Lymphoma Responding to Bortezomib Alone and in Combination With Dexamethasone, Gemcitabine, Oxaliplatin, Cytarabine, and Pegfilgrastim Chemotherapy and Lenalidomide Alone. J Clin Oncol 2010; 28:e704-8. [DOI: 10.1200/jco.2010.30.0038] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michele Bibas
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Susanna Grisetti
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Lucia Alba
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Giovanna Picchi
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Franca Del Nonno
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Andrea Antinori
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
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Guan B, Zhang X, Hu W, Rao Q, Wang Y, Zhu Y, Wang H, Ma H, Zhou H, Zhou X. Plasmablastic lymphoma of the oral cavity in an HIV-negative patient. Ann Diagn Pathol 2010; 15:436-40. [PMID: 20952277 DOI: 10.1016/j.anndiagpath.2010.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Revised: 05/10/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
Abstract
Plasmablastic lymphoma (PBL) is a rare, highly aggressive lymphoma typified by immunoblast-like cells with abundant basophilic cytoplasm and paranuclear hof. It shows absent expression of CD45 and CD20. In contrast, it displays a constant reaction with CD138 and VS38c. It may be easily misinterpreted as some other lymphoma. An exhaustive integration of clinical, morphologic, phenotypic, and molecular features is important to exclude misdiagnosis and inappropriate treatment. We report a case of HIV-negative PBL arising on the left areas of posterior teeth mucosa of a 58-year-old man. Immunohistochemically, the tumor cell was immunoreactive for CD138, VS38c, VEGF, and vimentin; Ki-67 showed a high proliferation rate. Epstein-Barr virus (in situ hybridization) was nonreactive, and IgH gene rearrangement was identified by polymerase chain reaction amplification products. A diagnosis of PBL was rendered.
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Affiliation(s)
- Bing Guan
- Department of Pathology, School of Medicine Nanjing University/Nanjing Jinling Hospital, Nanjing 210002, PR China
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