title: 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.affiliation: The Warren Alpert Medical School of Brown University, Division of Hematology and Oncology, The Miriam Hospital, Providence, RI, USA. jcastillo@lifespan.org
authors.forename: Jorge J
authors.initials: JJ
authors.lastname: Castillo
authors.forename: Michael
authors.initials: M
authors.lastname: Furman
authors.forename: Brady E
authors.initials: BE
authors.lastname: Beltrán
authors.forename: Michele
authors.initials: M
authors.lastname: Bibas
authors.forename: Mark
authors.initials: M
authors.lastname: Bower
authors.forename: Weina
authors.initials: W
authors.lastname: Chen
authors.forename: José L
authors.initials: JL
authors.lastname: Díez-Martín
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Liu
authors.forename: Roberto N
authors.initials: RN
authors.lastname: Miranda
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Nahid M
authors.initials: NM
authors.lastname: Nanaji
authors.forename: José-Tomás
authors.initials: JT
authors.lastname: Navarro
authors.forename: Adam C
authors.initials: AC
authors.lastname: Seegmiller
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
mesh_terms: D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult