Plasmablastic Lymphoma – A Single Institution Experience.

Plasmablastic lymphoma (PL) is a rare subtype of B-cell Non Hodgkin lymphoma that often involves the oral cavity of HIV-positive individuals but according to the WHO classification may occur in other sites.

A retrospective review of the charts of 25 HIV+ patients with PL who were seen from 2004 until 2008 was undertaken. Prognostic factors for outcome were determined by non parametric statistics. Survival was determined by the Kaplan and Meier method.

Data from 12 male and 13 female patients with a median age of 35 years (30-57) were reviewed. Patients were mostly Ann Arbor stage 1 (44%) or stage 4 (40%). 92% of patients had extranodal involvement. The commonest extranodal site was the oral cavity, nasopharynx or maxillary sinus (32%), followed by bone (28%). Overall 76% presented with malignant lesions outside the oral cavity. At presentation median ECOG performance status and IPI was 1. Median LDH was 708 IU (310-17010). Median CD4 count was 63 ×10⁶ /l (23-368). HIV infection was detected in 32% of patients at the time of lymphoma diagnosis; 20% had been on antiretroviral (ARV) therapy in excess of 6 months prior to presentation and 52% had been treated or continued treatment for tuberculosis (TB). Patients not yet on ARV were commenced on this treatment together with chemotherapy. All received anthracycline-containing (CHOP) chemotherapy and 19 had 4 or more cycles, while 5 were lost to follow up. 14 patients (56%) received radiotherapy either as palliation (6 patients) or involved field radiotherapy after achieving CR (8 patients). At median overall survival of 267 (27-1246) days 48% have achieved CR and 10 patients (40%) survive disease free for longer than 1 year. More favourable outcome was associated with any radiotherapy (p=0.01) and involved field radiotherapy (p=0.016).

In South Africa PL is associated with late HIV infection and frequently presents outside the oropharynx. The management is complicated by comorbidities, mainly TB infection. However, PL is responsive to chemotherapy and particularly involved field radiotherapy, which in some patients is associated with improved response and long term survival.

No relevant conflicts of interest to declare.