Human immunodeficiency virus-associated plasmablastic lymphoma

Poor prognosis in the era of highly active antiretroviral therapy

Authors


  • Presented at the 53rd Annual Meeting of the American Society of Hematology; December 10-13, 2011; San Diego, CA.

  • Dr. Beltrán thanks Drs. Rocio Reátegui and Domingo Morales from the Department of Oncology and Pathology at Edgardo Rebagliati Martins National Hospital. Dr. Bibas thanks Dr. Andrea Antinori, Chief of the Clinical Research Department at Lazzaro Spallanzani National Institute for Infections Diseases. Dr. Diez-Martin thanks Pascual Balsalobre, Transplant Coordinator at Gregorio Marañón General University Hospital. Dr. Liu thanks Dr. Ling Zhang, hematopathologist at Moffitt Cancer Center. Dr. Navarro thanks Drs. José-Maria Ribera, José-Luis Mate, and Gustavo Tapia at Germans Trias i Pujol Hospital. Dr. Vose thanks Martin Bast, Lead Coordinator of the Lymphoma Study Group at the University of Nebraska Medical Center.

Abstract

BACKGROUND:

Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell lymphoma strongly associated with human immunodeficiency virus (HIV) infection. The authors conducted a multi-institutional, retrospective study to describe characteristics and determine prognostic factors in HIV-associated PBL.

METHODS:

For this study, the investigators included consecutive, HIV-positive patients diagnosed between the years 2000 and 2010 whose tumors had a plasmablastic morphology, were cluster of differentiation 20 (CD20)-negative, and expressed markers of plasmacytic differentiation.

RESULTS:

Fifty patients from 13 institutions were evaluated. The median age was 43 years, and there was a male predominance. The median count of cells that were positive for CD4 (a glycoprotein expressed on the surface of T-helper cells, monocytes, macrophages, and dendritic cells) was 206 cells/mm3. At presentation, 90% of patients had extranodal involvement, 69% presented with advanced stage disease, and 27% had oral involvement. Rearrangements of v-myc myelocytomatosis viral oncogene homolog (MYC) were detected in 41% of the tested patients. Eighty-five percent of patients received chemotherapy, with 63% receiving cyclophosphamide, doxorubicin, vincristine, and prednisone and 37% receiving more intensive regimens. The complete response (CR) rate was 66%. The median overall survival (OS) was 11 months regardless of the intensity of chemotherapy. In the survival analysis, an Eastern Cooperative Oncology Group performance status ≥2, advanced stage, and MYC rearrangements were associated significantly with a worse outcome, whereas attaining a CR with chemotherapy was associated with a better outcome.

CONCLUSIONS:

The prognosis of PBL in HIV-infected individuals remains poor in the highly active antiretroviral therapy era. Intensive chemotherapy regimens do not seem to increase survival in patients with HIV-associated PBL. Cancer 2012. © 2012 American Cancer Society.

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