Human immunodeficiency virus-associated plasmablastic lymphoma: poor prognosis in the era of highly active antiretroviral therapy.

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/mm(3) . 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.

• Authors: Jorge J Castillo, Michael Furman, Brady E Beltrán, Michele Bibas, Mark Bower, Weina Chen, José L Díez-Martín, Jane J Liu, Roberto N Miranda, Silvia Montoto, Nahid M Nanaji, José-Tomás Navarro, Adam C Seegmiller, Julie M Vose
• Journal: Cancer (Cancer) Vol. 118 Issue 21 Pg. 5270-7 (Nov 01 2012) ISSN: 1097-0142 [Electronic] United States
• PMID: 22510767 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2012 American Cancer Society.

Topics

• Adult
• Aged
• Antiretroviral Therapy, Highly Active
• Female
• HIV Infections (complications, drug therapy)
• Humans
• Lymphoma, AIDS-Related (diagnosis, drug therapy, pathology)
• Lymphoma, B-Cell (complications, diagnosis, pathology)
• Male
• Middle Aged
• Prognosis
• Young Adult