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

Abstract

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