The Emerging Treatment Options of Plasmablastic Lymphoma: Analysis of 173 Individual Patient Outcomes

Nafie F Makady; David Ramzy; Ramy Ghaly; Raafat R Abdel-Malek; Kyrillus S Shohdy

doi:10.1016/j.clml.2020.11.025

The Emerging Treatment Options of Plasmablastic Lymphoma: Analysis of 173 Individual Patient Outcomes

Clin Lymphoma Myeloma Leuk. 2021 Mar;21(3):e255-e263. doi: 10.1016/j.clml.2020.11.025. Epub 2020 Dec 3.

Authors

Nafie F Makady¹, David Ramzy², Ramy Ghaly², Raafat R Abdel-Malek³, Kyrillus S Shohdy⁴

Affiliations

¹ Department of Clinical Oncology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: nafie.makady@kasralainy.edu.eg.
² Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.
³ Department of Clinical Oncology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.
⁴ Department of Clinical Oncology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt; Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY.

PMID: 33419717
DOI: 10.1016/j.clml.2020.11.025

Abstract

Plasmablastic lymphoma (PBL) is a newly recognized aggressive subtype of non-Hodgkin lymphoma. Its rarity hinders testing effective treatment options in clinical trials. We conducted a systematic review of PubMed and our internal records to retrieve patients with a PBL diagnosis with evaluable treatment outcomes. Aggressive chemotherapy was defined as more intense regimens than CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone). We compiled a meta-dataset of 173 patients. The median age at diagnosis was 48.5 years, 75% of patients were male, and stages III/IV accounted for 47% of the cohort. Of 138 patients with known response status after first-line chemotherapy, 63 (45%) achieved a complete response with a 2-year relapse-free survival of 71.6%. Sixty-nine (50%) patients received first-line CHOP. There was no significant difference in the objective response rate among the 2 most commonly used regimens, CHOP and DA-EPOCH (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) (69% vs. 79%; P = .4). The median follow-up was 9 months, and the 2-year overall survival (OS) was 47.4%. A univariate analysis identified factors associated with worse OS, including stage III/IV (hazard ratio [HR], 2.82; P < .001), human herpes virus-8-positive (HR, 3.30; P = .01), bone marrow (HR, 1.07; P = .035), and cardiorespiratory involvement (HR, 2.26; P = .015). Meanwhile, Epstein-Varr virus-encoded small RNA-positivity (HR, 0.31; P < .001) and involvement of head and neck (HR, 0.44; P = .009) were associated with better OS. Multivariate analysis showed that aggressive chemotherapy was significantly associated with better OS (HR, 0.22; P = .016). Patients with PBL with high-risk features, such as advanced stage, human herpes virus-8-positivity, bone marrow, and cardiorespiratory involvement, require more aggressive chemotherapy. Bortezomib and lenalidomide are promising add-on agents.

Keywords: Chemotherapy; Immunomodulatory drugs; Non-Hodgkin lymphoma; Proteasome inhibitors; Systematic review.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / adverse effects
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Clinical Decision-Making
Comorbidity
Disease Management
Disease Susceptibility
Gene Expression Profiling
Humans
Kaplan-Meier Estimate
Plasmablastic Lymphoma / diagnosis
Plasmablastic Lymphoma / etiology
Plasmablastic Lymphoma / mortality*
Plasmablastic Lymphoma / therapy*
Prognosis
Proportional Hazards Models
Treatment Outcome