jorge j. castillo, md assistant professor of...
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Plasmablastic lymphoma
Jorge J. Castillo, MD
Assistant Professor of Medicine
Harvard Medical School
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KI67
CD20
EBER
CD38
Patients’
characteristics
• N=16
• 14 men
• 15 HIV+
• 11 stage I; 5 stage IV
• 6 chemo; 4 RT; 6 chemo-RT
• 10 died
• 2 alive
• Median OS 6 months
Delecluse et al. Blood 1997 PBL is a real and distinct entity
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Castillo et al. Am J Hematol 2008 There is PBL outside of the oral cavity
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Castillo et al. Oncologist 2010 Survival is short, regardless of treatment
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Castillo et al. Leuk Lymphoma 2010
There is PBL in
HIV-negative patients
and it might have
a worse survival
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Patients’ characteristics
• N=50
• Men 78%
• CD4+ count >200 42%
• HAART 100%
• Stage III/IV 69%
• CHOP 63%
• Other 37%
• MYC rearrangement 41%
• ALK 0%
• HHV8 LANA/PCR 0% Even with chemotherapy and HAART,
PBL patients have a bad outcome Castillo et al. Cancer 2012
0.0
00.2
50.5
00.7
51.0
0
Ove
rall
surv
ival p
rob
abili
ty
0 12 24 36 48 60 72 84 96 108Time in months
No MYC rearrangement MYC rearrangement
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Castillo et al. Blood 2015
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Castillo et al. Blood 2015
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Reports on bortezomib in PBL
Bose. Eur J Haematol 2009; Lipstein. Clin Lymphoma Leuk Myeloma 2010; Saba. Onkologie 2013; Hirosawa. Biomarker Res 2015
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Patients
Case 1
• 40M, HIV+, CD4 290, stage IV
(rectal and pharyngeal), MYC+
60%, EBER+, alive at 4 years
Case 2
• 36M, HIV+, CD4 34, stage IV
(rectal and lung nodules),
EBER+, alive at 3 years
Case 3
• 66M, HIV-, stage II (non-
obstructing colonic mass),
MYC+ 15%, alive at 2.5 years
Castillo et al. Br J Haematol 2015
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Reports on bortezomib and
chemotherapy in PBL
Fernandez-Alvarez et al. Leuk Lymphoma 2016
Fedele et al. Ann Hematol 2016
2 patients alive at 12 and 24 months;
1 patient died at 12 months
Patient alive at 2 years
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The role of transplant in PBL
Al-Malki et al. Biol Blood Marrow Transplant 2014
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Recommended treatment algorithm
Diagnosis of plasmablastic lymphoma
HIV negative HIV positive
Advanced stage Advanced stage Early stage
V-EPOCH x 6 + HAART V-EPOCH x 6 V-EPOCH x 4 + XRT
Complete response Less than
complete response
Complete response
Surveillance ASCT vs. Surveillance
Salvage chemotherapy
+ ASCT
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Key messages
• PBL is a real and distinct entity
• There is PBL outside of the oral cavity
• There is PBL in HIV-negative patients and it might
have a worse survival
• Survival is short, regardless of treatment
• Bortezomib in combination with chemotherapy might
improve outcomes in PBL
• ASCT in CR1 might improve outcomes in HIV-
negative PBL
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Plasmablastic lymphoma
Jorge J. Castillo, MD
Assistant Professor of Medicine
Harvard Medical School