Clinical and pathological aspects of human immunodeficiency virus-associated plasmablastic lymphoma: analysis of 24 cases.
Plasmablastic lymphoma (PBL) is a rare AIDS-related malignancy with a poor prognosis. Little is known about this entity, and no standard treatment regimen has been defined. To establish an adequate treatment strategy, we investigated 24 cases of PBL arising in human immunodeficiency virus-positive individuals. Most of the patients were in the AIDS stage, with a median CD4 count of 67.5/µL. Lymph nodes (58 %), gastrointestinal tract (42 %), bone marrow (39 %), oral cavity (38 %), and CNS (18 %) were the most commonly involved sites. Histology findings for the following were positive at varying rates, as follows: CD10 (56 %); CD30 (39 %); CD38 (87 %); MUM-1 (91 %); CD138 (79 %); EBER (91 %); and LMP-1 (18 %). There was a marked increase in patients in 2011-12, and the cases found in that period appeared to be more aggressive, showing a higher rate of advanced-stage PBL. Fourteen cases were treated with CHOP, while the others were treated with more intensive regimens, including bortezomib and hematopoietic stem cell transplantation. The overall median survival time was 15 months. A CD4 count of >100/µL at diagnosis and attaining complete remission in the first-line chemotherapy were associated with better outcomes (P = 0.027 and 0.0016, respectively). Host immune status and chemosensitivity are associated with improved prognosis in PBL.
Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan. ykoizumi@aichi-med-u.ac.jp.|Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan. ykoizumi@aichi-med-u.ac.jp.|Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan. ykoizumi@aichi-med-u.ac.jp.
Yusuke
Y
Koizumi
Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan.
Tomoko
T
Uehira
Department of Pathology, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
Yasunori
Y
Ota
Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan.
Yoshihiko
Y
Ogawa
Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan.
Keishiro
K
Yajima
AIDS Clinical Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan.
Junko
J
Tanuma
Department of Laboratory Medicine, Tokyo Medical University, Tokyo, Japan.
Mihoko
M
Yotsumoto
Department of Hematology, National Center for Global Health and Medicine Hospital, Tokyo, Japan.
Shotaro
S
Hagiwara
Department of Hematology and Oncology, University of Fukui Hospital, Fukui, Fukui, Japan.
Satoshi
S
Ikegaya
Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan.
Dai
D
Watanabe
Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan.
Hitoshi
H
Minamiguchi
Department of Hematology, Shiga University of Medical Science, Otsu, Shiga, Japan.
Keiko
K
Hodohara
Division of Biostatistics, Clinical Research Center, Aichi Medical University, Nagakute, Aichi, Japan.
Kenta
K
Murotani
Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
Hiroshige
H
Mikamo
Department of Hematology, Kawasaki Medical School, Kawasaki, Okayama, Japan.
Hideho
H
Wada
Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Atsushi
A
Ajisawa
Department of Infectious Diseases, Osaka National Hospital, Osaka, Osaka, Japan.
Takuma
T
Shirasaka
Department of Hematology, Nagoya Medical Center, Nagoya, Aichi, Japan.
Hirokazu
H
Nagai
Department of Pathology, Osaka National Hospital, Osaka, Osaka, Japan.
Yoshinori
Y
Kodama
Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Tsunekazu
T
Hishima
Department of Pathology, Kyorin University School of Medicine, Mitaka, Tokyo, Japan.
Makoto
M
Mochizuki
Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan.
Harutaka
H
Katano
Center for AIDS Research, Kumamoto University, Kumamoto, Kumamoto, Japan.
Seiji
S
Okada
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D018380:Hematopoietic Stem Cell Transplantation; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D000069293:Plasmablastic Lymphoma / Q000175:diagnosis / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D011241:Prednisone / Q000627:therapeutic use; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
D044966:Anti-Retroviral Agents; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
Acquired immunodeficiency syndrome; CD4; Combination antiretroviral therapy; Epstein–Barr virus; Human immunodeficiency virus; Plasmablastic lymphoma