Human immunodeficiency virus-associated plasmablastic lymphoma: Poor prognosis in the era of highly active antiretroviral therapy

Jorge J. Castillo, Michael Furman, Brady E. Beltrán, Michele Bibas, Mark Bower, Weina Chen, José L. Díez-Martín, Jane J. Liu, Roberto N. Miranda, Silvia Montoto, Nahid M. Nanaji, José Tomás Navarro, Adam C. Seegmiller, Julie M. Vose

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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.

Original languageEnglish (US)
Pages (from-to)5270-5277
Number of pages8
JournalCancer
Volume118
Issue number21
DOIs
StatePublished - Nov 1 2012

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Highly Active Antiretroviral Therapy
HIV
Drug Therapy
Survival
Differentiation Antigens
Vincristine
B-Cell Lymphoma
Virus Diseases
Survival Analysis
Helper-Inducer T-Lymphocytes
Prednisone
Oncogenes
Doxorubicin
Cyclophosphamide
Dendritic Cells
Plasmablastic Lymphoma
Monocytes
Neoplasms
Glycoproteins
Retrospective Studies

Keywords

  • acquired immunodeficiency syndrome
  • chemotherapy
  • highly active antiretroviral therapy
  • human immunodeficiency virus
  • plasmablastic

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Human immunodeficiency virus-associated plasmablastic lymphoma : Poor prognosis in the era of highly active antiretroviral therapy. / Castillo, Jorge J.; Furman, Michael; Beltrán, Brady E.; Bibas, Michele; Bower, Mark; Chen, Weina; Díez-Martín, José L.; Liu, Jane J.; Miranda, Roberto N.; Montoto, Silvia; Nanaji, Nahid M.; Navarro, José Tomás; Seegmiller, Adam C.; Vose, Julie M.

In: Cancer, Vol. 118, No. 21, 01.11.2012, p. 5270-5277.

Research output: Contribution to journalArticle

Castillo, JJ, Furman, M, Beltrán, BE, Bibas, M, Bower, M, Chen, W, Díez-Martín, JL, Liu, JJ, Miranda, RN, Montoto, S, Nanaji, NM, Navarro, JT, Seegmiller, AC & Vose, JM 2012, 'Human immunodeficiency virus-associated plasmablastic lymphoma: Poor prognosis in the era of highly active antiretroviral therapy', Cancer, vol. 118, no. 21, pp. 5270-5277. https://doi.org/10.1002/cncr.27551
Castillo, Jorge J. ; Furman, Michael ; Beltrán, Brady E. ; Bibas, Michele ; Bower, Mark ; Chen, Weina ; Díez-Martín, José L. ; Liu, Jane J. ; Miranda, Roberto N. ; Montoto, Silvia ; Nanaji, Nahid M. ; Navarro, José Tomás ; Seegmiller, Adam C. ; Vose, Julie M. / Human immunodeficiency virus-associated plasmablastic lymphoma : Poor prognosis in the era of highly active antiretroviral therapy. In: Cancer. 2012 ; Vol. 118, No. 21. pp. 5270-5277.
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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.",
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AU - Castillo, Jorge J.

AU - Furman, Michael

AU - Beltrán, Brady E.

AU - Bibas, Michele

AU - Bower, Mark

AU - Chen, Weina

AU - Díez-Martín, José L.

AU - Liu, Jane J.

AU - Miranda, Roberto N.

AU - Montoto, Silvia

AU - Nanaji, Nahid M.

AU - Navarro, José Tomás

AU - Seegmiller, Adam C.

AU - Vose, Julie M.

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N2 - 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.

AB - 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.

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