The Emerging Treatment Options of Plasmablastic Lymphoma: Analysis of 173 Individual Patient Outcomes |
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| Authors: | Nafie F. Makady David Ramzy Ramy Ghaly Raafat R. Abdel-Malek Kyrillus S. Shohdy |
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| Affiliation: | 1. Department of Clinical Oncology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt;2. Guy''s and St. Thomas'' NHS Foundation Trust, London, United Kingdom;3. Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt;4. Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY;1. Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia;2. Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;3. Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region (MNGHA-WR), Jeddah, Kingdom of Saudi Arabia;4. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia;1. Real-world Evidence/Data Analytics Center of Excellence, Pharmerit International LP, Bethesda, MD;2. Market Access, Taiho Oncology, Princeton, NJ;3. Yale Cancer Center, Smilow Cancer Hospital at Yale New Haven, New Haven, CT;1. Department of Cancer Pharmacology, Levine Cancer Institute/Atrium Health, Charlotte, NC;2. Department of Biostatistics, Levine Cancer Institute/Atrium Health, Charlotte, NC;3. Division of Plasma Cell Disorders, Levine Cancer Institute/Atrium Health, Charlotte, NC;4. Department of Pharmacy, Levine Cancer Institute/Atrium Health, Charlotte, NC;1. Division of Medical Oncology, University of Washington Medicine, Seattle, WA;2. Clinical Research Division, Fred Hutch Cancer Research Center, Seattle, WA;3. Department of Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, WA;4. Division of Hematology;5. Division of Nuclear Medicine, Department of Radiology;6. Department of Pathology, University of Washington Medicine, Seattle, WA;1. Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer, Houston, TX;2. Division of Hematology & Oncology, George Washington University Cancer Center, Washington, DC |
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| Abstract: | Plasmablastic lymphoma (PBL) is a newly recognized aggressive subtype of non-Hodgkin lymphoma. Its rarity hinders testing effective treatment options in clinical trials.We conducted a systematic review of PubMed and our internal records to retrieve patients with a PBL diagnosis with evaluable treatment outcomes. Aggressive chemotherapy was defined as more intense regimens than CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). We compiled a meta-dataset of 173 patients. The median age at diagnosis was 48.5 years, 75% of patients were male, and stages III/IV accounted for 47% of the cohort. Of 138 patients with known response status after first-line chemotherapy, 63 (45%) achieved a complete response with a 2-year relapse-free survival of 71.6%. Sixty-nine (50%) patients received first-line CHOP. There was no significant difference in the objective response rate among the 2 most commonly used regimens, CHOP and DA-EPOCH (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) (69% vs. 79%; P = .4). The median follow-up was 9 months, and the 2-year overall survival (OS) was 47.4%. A univariate analysis identified factors associated with worse OS, including stage III/IV (hazard ratio [HR], 2.82; P < .001), human herpes virus-8–positive (HR, 3.30; P = .01), bone marrow (HR, 1.07; P = .035), and cardiorespiratory involvement (HR, 2.26; P = .015). Meanwhile, Epstein-Varr virus-encoded small RNA-positivity (HR, 0.31; P < .001) and involvement of head and neck (HR, 0.44; P = .009) were associated with better OS. Multivariate analysis showed that aggressive chemotherapy was significantly associated with better OS (HR, 0.22; P = .016).Patients with PBL with high-risk features, such as advanced stage, human herpes virus-8–positivity, bone marrow, and cardiorespiratory involvement, require more aggressive chemotherapy. Bortezomib and lenalidomide are promising add-on agents. |
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| Keywords: | Chemotherapy Immunomodulatory drugs Non-Hodgkin lymphoma Proteasome inhibitors Systematic review |
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