Plasmablastic Lymphoma: A Systematic Review

The Warren Alpert Medical School of Brown University, Division of Hematology and Oncology, The Miriam Hospital, Providence, RI, USA.
The Scientific World Journal (Impact Factor: 1.73). 01/2011; 11:687-96. DOI: 10.1100/tsw.2011.59
Source: PubMed


Plasmablastic lymphoma (PBL) is a very aggressive variant of diffuse large B-cell lymphoma initially described in the oral cavity of HIV-infected individuals. PBL represents a diagnostic challenge given its characteristic morphology and lack of CD20 expression, and also a therapeutic challenge, with early responses to therapy, but with high relapse rates and poor prognosis. In recent years, our understanding and clinical experience with PBL has increased in both HIV-positive and -negative settings. However, given its rarity, most of the data available rely on case reports and case series. The main goal of this article is to systematically review the most recent advances in epidemiology; pathophysiology; clinical, pathologic, and molecular characteristics; therapy; and prognosis in patients with PBL. Specific covered topics include new pathological markers for diagnosis, its association with Epstein-Barr virus, and the need of more intensive therapies.

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Available from: Jorge J Castillo,
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    • "Previously described treatment approaches seem to either focus on treating the underlying HIV infection with HAART therapy or using specific chemotherapy regimens. Chemotherapy options have consisted of traditional CHOP or CHOP-like regimens, though current NCCN guidelines recommend use of more intensive regimens like EPOCH or hyper CVAD, since PBL has a more aggressive clinical course than other types of DLBCL [6]. These current treatment approaches have little translation to the subset of HIV-negative elderly patients with PBL who may not tolerate or wish to pursue CHOP or intensive chemotherapy regimens. "
    Open Journal of Hematology 02/2015; 6. DOI:10.13055/ojhmt_6_1_1.150228
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    • "The utility of HIV-OL in facilitating diagnosis, evaluation, and prognosis of HIV infection has been reported and claimed in many studies (Greenspan, 1997; Patton et al, 1999; Ranganathan et al, 2000; Coogan et al, 2005; Nittayananta et al, 2010b). However, some of the HIV-OLs such as OC are very commonly seen also in HIV-negative patients, whereas others, such as OHL or oral plasmablastic lymphoma, that at first were considered specific markers of infection later on were also found in non-immune compromised HIV-negative subjects (Piperi et al, 2010; Castillo and Reagan, 2011). There is a remarkable scarcity of studies investigating the ability of HIV-OL to predict HIV infection (Table 6). "
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    ABSTRACT: Human immunodeficiency virus-related oral lesions (HIV-OLs), such as oral candidiasis (OC) and oral hairy leukoplakia (OHL), have been recognized as indicators of immune suppression since the beginning of the global HIV epidemic. The diagnosis and management of HIV disease and spectrum of opportunistic infection has changed over the past 30 years as our understanding of the infection has evolved. We investigated the following controversial topics: (i) Are oral manifestations of HIV still relevant after the introduction of highly active antiretroviral therapy (HAART)? (ii) Can we nowadays still diagnose HIV infection through oral lesions? (iii) Is the actual classification of oral manifestations of HIV adequate or does it need to be reviewed and updated? (iv) Is there any novelty in the treatment of oral manifestations of HIV infection? Results from extensive literature review suggested the following: (i) While HAART has resulted in significant reductions in HIV-OLs, many are still seen in patients with HIV infection, with OC remaining the most common lesion. While the relationship between oral warts and the immune reconstitution inflammatory syndrome is less clear, the malignant potential of oral human papillomavirus infection is gaining increasing attention. (ii) Effective antiretroviral therapy has transformed HIV from a fatal illness to a chronic manageable condition and as a result expanded screening policies for HIV are being advocated both in developed and in developing countries. Affordable, reliable, and easy-to-use diagnostic techniques have been recently introduced likely restricting the importance of HIV-OLs in diagnosis. (iii) The 1993 EC-Clearinghouse classification of HIV-OLs is still globally used despite controversy on the relevance of periodontal diseases today. HIV-OL case definitions were updated in 2009 to facilitate the accuracy of HIV-OL diagnoses by non-dental healthcare workers in large-scale epidemiologic studies and clinical trials. (iv) Research over the last 6 years on novel modalities for the treatment of HIV-OLs has been reported for OC and OHL.
    Oral Diseases 03/2013; 19(6). DOI:10.1111/odi.12103 · 2.43 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    Cancer 04/2012; 118(21):5270-7. DOI:10.1002/cncr.27551 · 4.89 Impact Factor
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