Favorable Outcomes with CHOP Therapy in Plasmablastic Lymphoma in HIV Positive Patients.

Plasmablastic lymphoma (PBL) is a rapidly progressive variant of diffuse large-cell lymphoma predominantly diagnosed in HIV positive patients. It is frequently associated with latent EBV infection and is often lacking expression of CD20 and CD45. A retrospective study of HIV positive patients diagnosed with PBL to determine outcomes after CHOP therapy. Two HIV positive patients diagnosed with PBL and treated with CHOP were identified. The first patient is a 48 year old male with CD4 count of 80 cells/mm3 on HAART, who presented with a rectal mass. Pathologic exam revealed granulation tissue with marked inflammation. A second colonoscopy because of ongoing rectal bleeding was done. Histologic exam was interpreted as infiltrating poorly differentiated carcinoma. The third biopsy obtained via colonoscopy (after developing bowel obstruction) was reported as a high grade tumor with neuroendocrine features. The patient received one dose of cisplatin 60 mg/m2 and irinotecan 60 mg/m2 and radiation therapy. Patient underwent a diverting colostomy. The immunohistochemical exam of the tissue was negative for CD20, CD3 and positive for CD 138, suggestive of the diagnosis of plasmablastic lymphoma. In situ hybridization for EBV was positive. The patient received 6 cycles of CHOP (cytoxan 750 mg/m2, vincristine 1.4 mg/m2, doxorubicine 50/m2 and prednisone 100 mg) chemotherapy and 6 more cycles of radiation therapy. He is in complete remission 16 months after the diagnosis, and continues to be followed. The second patient is a 44 year old female on HAART with CD4 count of 415 cells/mm3, who presented with the swelling of the right jaw for three weeks. The histologic exam of the tissue, obtained by the incision biopsy of the mass, favored plasmablastic lymphoma. Immunohistochemical analysis tested positive for CD3, CD138 and CD45. In situ hybridization for EBV RNA was positive. Patient received 3 cycles of CHOP regimen and radiation to the jaw. She has not shown any evidence of relapse and is in complete remission 22 months after diagnosis, and continues to be followed. Durable remissions, 16 and 22 months, were achieved with CHOP therapy in HIV positive patients with PBL. This study supports the use of CHOP as an effective treatment of PBL in HIV positive patients.