Plasmablastic lymphoma following transplantation

Plasmablastic Lymphoma Causing Adult Intussusception After Cardiac Transplantation

Intussusception in adults is a rare occurrence at approximately 5% and malignancy as the cause comprises half that number. The most common malignancies found are primary adenocarcinoma, metastatic carcinoma, lymphoma, and gastrointestinal stromal tumors. Lymphoma is the second most common. The management of adult intussusception is generally surgical, which is due to the higher likelihood of malignancy being the underlying cause. The patient's history helps to direct management and the most likely underlying diagnosis. This is especially important in patients who are immunosuppressed and with a history of lymphoproliferative disease. Early management and proper surgical intervention allow for the best survival rate. Here we present a case of adult intussusception caused by a rare and aggressive type of non-Hodgkin lymphoma.

Plasmablastic Lymphoma Found on Autopsy in a Post-Transplant Patient

Plasmablastic lymphoma (PBL) is an aggressive lymphoma often seen in immunodeficient patients. It can be a diagnostic challenge given its high-grade appearance and lack of staining for traditional B-cell markers. We present an interesting case of a 65-year-old African-American female who presented to the emergency department (ED) with complaints of progressively worsening weakness, fatigue, and dizziness for one month, and dark-colored urine for three days. The patient's medical history was remarkable for a renal and pancreatic transplant in 2008.

[Clinical characteristics and survival analysis of eight cases HIV-negative plasmablastic lymphoma]

目的

提高对人免疫缺陷病毒（HIV）阴性浆母细胞淋巴瘤的认识。

方法

回顾性分析北京协和医院1997年1月至2015年5月确诊的8例HIV阴性浆母细胞淋巴瘤患者的临床资料，分析其临床特征及转归。

结果

8例HIV阴性浆母细胞淋巴瘤中男3例，女5例，中位年龄60（43~80）岁，其中4例存在导致免疫功能低下的疾病或状态。8例患者均有结外受累，2例Ann Arbor分期为Ⅰ~Ⅱ期，6例为Ⅳ期，其中5例有骨髓受累。所有患者均弥漫表达CD38和CD138，B细胞标志包括PAX-5及Bcl-6少见。5例患者进行EBV-DNA检测，均为阴性。接受化疗并规律随访的7例患者中位随访36（11~57）个月，中位无进展生存时间为15（6~52）个月，中位总生存时间为36（2~52）个月；其中4例采用了硼替佐米联合化疗，3例有效，但疗效难以维持，分别于治疗后2、9、21个月疾病进展。2例Ⅰ~Ⅱ期患者均治疗有效，未出现疾病进展，持续存活；5例Ⅳ期患者化疗后虽然有效，但疗效难以维持，中位总生存时间仅12（6~52）个月，中位无进展生存时间仅10（2~21）个月。

结论

该组HIV阴性浆母细胞淋巴瘤患者以中老年为主，临床呈现高侵袭性，均出现结外（尤其是骨髓）受累，其免疫表型与浆细胞瘤较为接近，分期较晚的患者预后不良。

Bortezomib in combination with dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) induces long-term survival in patients with plasmablastic lymphoma: a retrospective analysis

Plasmablastic lymphoma (PBL) is a rare and aggressive form of B-cell non-Hodgkin lymphoma. This subtype of lymphoma has a post-germinal center cell-of-origin called the plasmablast, and the immunophenotype is more consistent with that of a plasma cell than a lymphocyte. Because of these unique features, PBL is notoriously difficult to treat. Case reports and small reviews have evaluated the addition of agents directed against plasma cell disorders in combination with traditional lymphoma-directed regimens. We describe the largest case series to date, with the longest follow-up, evaluating bortezomib in combination with etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (V-EPOCH) for the treatment of PBL. Our results show that this is a safe and effective regimen with an overall and complete response rate of 100% and 2-year overall survival of 50%.

Clinicopathologic comparison of plasmablastic lymphoma in HIV-positive, immunocompetent, and posttransplant patients: single-center series of 25 cases and meta-analysis of 277 reported cases

Plasmablastic lymphoma (PBL) is a rare B-cell non-Hodgkin lymphoma often associated with Epstein-Barr virus (EBV) infection. To gain insight in this aggressive lymphoma subtype, the clinicopathologic characteristics of 25 unpublished single-center PBLs (2 in acquired immunodeficiency syndrome patients, 11 in immunocompetent individuals [IC-PBL], 12 in transplant recipients [PT-PBL]) and of 277 reported PBLs were summarized. In the reported series, PBL patients were predominantly male (77%) with a median age at diagnosis of 46 years (range, 1.2 to 87 y). The majority of the biopsies (66%) was EBV positive. Extranodal presentation was most frequent (88%, of which 35% were oral, 18% gastrointestinal, 12% cutaneous). PBL was diagnosed in acquired immunodeficiency syndrome patients (50%), immunocompetent individuals (35%), and transplant recipients (14%). These subgroups differed in age at diagnosis (median: 41, 64, 47 y, respectively), primary localization (oral, oral, cutaneous, respectively), EBV positivity (75%, 50%, 67%, respectively), CD45 expression (31%, 33%, 70%, respectively), and C-MYC aberrations (78%, 44%, 38%, respectively). Ann Arbor stage I, EBV positivity, CD45 expression, and lack of C-MYC aberrations were associated with better outcome (P<0.05). Our series of IC-PBL and PT-PBL cases revealed differential expression of CD10 (0% vs. 42%, respectively), CD56 (22% vs. 42%, respectively), TP53 (67% vs. 8%, respectively), and BCL2 (88% vs. 25%, respectively). Gene expression analysis of 5 of our PT-PBLs revealed upregulation of DNMT3B, PTP4A3, and CD320 in EBV-positive PT-PBL and suggested a role for cancer/testis antigens. The results of this retrospective study suggest different pathogenic mechanisms of PBL in different immunologic settings and a potentially important impact of EBV and CD45 on prognosis.

Plasmablastic lymphoma following combination treatment with fludarabine and rituximab for nongastric mucosa-associated lymphoid tissue lymphoma: a case report and review of literature

Plasmablastic lymphoma (PBL) is an uncommon malignancy which predominantly occurs in the oral cavity of human immunodeficiency virus (HIV)-positive patients. Sporadic cases have been published describing PBL in immunocompetent patients as well as in immunodeficient patients following immunosuppressive therapy or transplantation. We hereby reported a case of PBL in a 69-year-old, HIV-negative male subjected to combination treatment with fludarabine and rituximab for nongastric mucosa-associated lymphoid tissue (MALT) lymphoma. The diagnosis of PBL was made with tumor cells of immunoblasts or plasmablasts morphology strongly positive for MUM-1, EMA and CD138, and partly positive for CD38, and negative for CD20, BCL-6, and CD56, and approximately 80% of which were positive for Ki-67. The case presented PBL after MALT, and a history of chemotherapy including fludarabine and rituximab led to the potential immunocompromised state. The patient died 5 months after the diagnosis of PBL.