Patients with human immunodeficiency virus (HIV) infection have an increased risk of developing plasmablastic lymphoma (PBL). In this study, we reviewed the clinicopathologic features of PBL in HIV+ patients in the era of highly active anti-retroviral therapy (HAART) from a single health center.
The morphologic, immunophenotypic and clinical features were reviewed in these HIV+ patients with PBL and univariate analysis was employed to determine the survival prognosis.
During the interval of 1/1/2008-12/30/2018, we identified 95 HIV+ patients with aggressive non-Hodgkin B-cell lymphomas. Among these patients, there were 21 (22%) patients with PBL (19 men and 2 women; median age: 45 years). Seven patients had PBL at their initial HIV diagnosis and 14 developed PBL after a median interval of 7.7 months of HIV diagnosis. Lymph nodes (n=10), oral cavity/sinonasal mass (n = 6) and rectal masses (n = 5) were the common involved sites, and 5 of 15 (33%) had bone marrow involvement. Lymphoma cells were immunoreactive for MUM-1/IRF4 (100%), CD138 (90%), CD45 (63%), CD79a (47%), and CD30 (25%). Proliferation rate assessed by Ki67 was ≥ 90% in 18/20 cases. Eighteen patients received chemotherapy including EPOCH (n = 13) and CHOP (n = 2). With a median follow-up time of 19 months, 9/17 patients died. Bone marrow involvement was associated with a poorer overall survival (median: 4.7 months, p = 0.015).
PBL is the second most common type of aggressive lymphoma and often presents in lymph nodes of patients with poorly controlled HIV infection. Bone marrow involvement is associated with a poorer outcome.