Human immunodeficiency virus‐associated plasmablastic lymphoma |
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| Authors: | Jorge J. Castillo MD Michael Furman MD Brady E. Beltrán MD Michele Bibas MD Mark Bower MD Weina Chen MD José L. Díez‐Martín MD Jane J. Liu MD Roberto N. Miranda MD Silvia Montoto MD Nahid M. Nanaji MD José‐Tomás Navarro MD Adam C. Seegmiller MD Julie M. Vose MD |
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| Affiliation: | 1. The Warren Alpert Medical School of Brown University, Division of Hematology and Oncology, The Miriam Hospital, Providence, Rhode IslandFax: (401) 793‐7132;2. The Warren Alpert Medical School of Brown University, Division of Hematology and Oncology, The Miriam Hospital, Providence, Rhode Island;3. Department of Oncology and Radiotherapy, Edgardo Rebagliati Martins National Hospital, Lima, Peru;4. Department of Clinical Research, Hematology, Lazzaro Spallanzani National Institute for Infections Diseases, Rome, Italy;5. Department of Medical Oncology, Chelsea and Westminster Hospital, London, United Kingdom;6. Ameripath/Quest Diagnostics, North Texas, Texas;7. Department of Hematology, Gregorio Mara?ón General University Hospital, Madrid, Spain;8. Department of Hematology and Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida;9. Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas;10. Center for Hemato‐Oncology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom;11. Department of Pathology, University of Maryland Medical Center, Baltimore, Maryland;12. Department of Hematology, Germans Trias i Pujol University Hospital, Barcelona, Spain;13. Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee;14. Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, Nebraska |
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| 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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| Keywords: | human immunodeficiency virus acquired immunodeficiency syndrome plasmablastic highly active antiretroviral therapy chemotherapy |
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