Abstract
BackgroundPlasmablastic lymphoma (PBL) is a rare aggressive neoplasm with lymphoid and plasmacytic differentiation that is commonly associated with immunodeficiency and an unfavorable prognosis. Clinicopathologic features have been largely derived from cases reports and small series with limited outcome analyses.Patients and methodsThe demographic, clinicopathologic features, and clinical outcomes of a cohort of 61 patients with PBL were reviewed and analyzed.ResultsPatients had a median age of 49 years (range 21–83 years) and most (49/61; 80 %) were men. Human immunodeficiency virus (HIV) status was available for 50 patients: 20 were HIV-positive and 30 HIV-negative. Twenty-three patients were immunocompetent. Abdominal/gastrointestinal complaints were the most common presenting symptoms, reported in 14 of 47 (30 %) of patients. At presentation, 24 of 43 (56 %) patients had stage III or IV disease. Epstein-Barr virus (EBV) was detected in 40 of 57 (70 %) cases. MYC rearrangement was identified in 10/15 (67 %) cases assessed, and MYC overexpression was seen in all cases assessed regardless of MYC rearrangement status. HIV-positive patients were significantly younger than those who were HIV-negative (median 42 vs. 58 years; p = 0.006). HIV-positive patients were also significantly more likely to have EBV-positive disease compared with HIV-negative patients (19/19, 100 % vs. 15/29, 52 %; p = 0.002). Patients who received CHOP chemotherapy tended to have better overall survival (OS) compared with those who received hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) (p = 0.078). HIV status had no impact on OS. Patients with EBV-positive PBL had a better event-free survival (EFS) (p = 0.047) but not OS (p = 0.306). Notably, OS was adversely impacted by age ≥50 years (p = 0.013), stage III or IV disease (p = <0.001), and lymph node involvement (p = 0.008).ConclusionsThe most significant prognostic parameters in patients with PBL are age, stage, and, to a lesser extent, EBV status. In this study, two-thirds of PBL cases assessed were associated with MYC rearrangement and all showed MYC overexpression.Electronic supplementary materialThe online version of this article (doi:10.1186/s13045-015-0163-z) contains supplementary material, which is available to authorized users.
Highlights
Plasmablastic lymphoma (PBL) is a rare type of nonHodgkin lymphoma in which the neoplastic cells are postulated to arise from plasmablasts, defined as short-lived B cells that have switched their transcriptional phenotype to a plasma cell gene expression program [1]
PBL commonly occurs in human immunodeficiency virus (HIV)-positive individuals, it may arise in association with other immunodeficiency or immunocompromised states such as organ transplantation, autoimmune diseases, and older age, as well as in immunocompetent individuals
PBL is defined as a high-grade lymphoma comprised of a diffuse proliferation of large neoplastic cells that resemble immunoblasts or plasmablasts expressing an immunophenotype resembling that of plasma cells [1, 4]
Summary
Plasmablastic lymphoma (PBL) is a rare type of nonHodgkin lymphoma in which the neoplastic cells are postulated to arise from plasmablasts, defined as short-lived B cells that have switched their transcriptional phenotype to a plasma cell gene expression program [1]. PBL commonly occurs in HIV-positive individuals, it may arise in association with other immunodeficiency or immunocompromised states such as organ transplantation, autoimmune diseases, and older age, as well as in immunocompetent individuals. PBL is defined as a high-grade lymphoma comprised of a diffuse proliferation of large neoplastic cells that resemble immunoblasts or plasmablasts expressing an immunophenotype resembling that of plasma cells [1, 4]. Plasmablastic lymphoma (PBL) is a rare aggressive neoplasm with lymphoid and plasmacytic differentiation that is commonly associated with immunodeficiency and an unfavorable prognosis. Clinicopathologic features have been largely derived from cases reports and small series with limited outcome analyses
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