Outcomes of patients with limited‐stage plasmablastic lymphoma: A multi‐institutional retrospective study

• Published in: American journal of hematology Vol. 98; no. 2; pp. 300 - 308
• Main Authors: Hess, Brian T., Giri, Anshu, Park, Yeonhee, Patel, Krina K., Link, Brian K., Nowakowski, Grzegorz S., Maliske, Seth M., Fortin, Sonia, Chavez, Julio C., Saeed, Hayder, Hill, Brian T., Mejia Garcia, Alex V., Maddocks, Kami J., Hanel, Walter, Wagner‐Johnston, Nina D., Messmer, Marcus R., Kahl, Brad S., Watkins, Marcus, Alderuccio, Juan Pablo, Lossos, Izidore S., Nathan, Sunita, Orellana‐Noia, Victor M., Portell, Craig A., Landsburg, Daniel J., Ayers, Emily C., Castillo, Jorge J.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-02-2023; Wiley Subscription Services, Inc
• Subjects: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy; Hematology; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Lymphoma; Medical prognosis; Neoplasm Recurrence, Local - etiology; Patients; Plasmablastic Lymphoma - pathology; Plasmablastic Lymphoma - therapy; Prognosis; Progression-Free Survival; Radiation; Retrospective Studies; Survival
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.26784

Plasmablastic lymphoma (PBL) is a rare entity, commonly associated with immunosuppressed states such as human immunodeficiency virus (HIV) infection or solid organ transplant. The clinical course is characterized by high relapse rates and a poor prognosis, leading some clinicians to recommend aggressive frontline therapy. However, a specific review of limited stage (LS) PBL patients is not available to evaluate outcomes and justify treatment recommendations. We performed a retrospective review of LS PBL cases to provide insight into this rare disease. Our cohort consisted of 80 stage I or II PBL patients from 13 US academic centers. With a median follow up of 34 months (1–196), the 3‐year progression‐free survival (PFS) and overall survival (OS) of the entire cohort were 72% (95% CI 62, 83) and 79% (95% CI 70, 89), respectively. The 3‐year PFS and OS of patients treated with frontline chemotherapy alone was 65% (95% CI 50, 84) and 71% (95% CI 56, 89), respectively, compared to 85% (95% CI 72, 100) and 96% (95% CI 89, 100), respectively, in patients treated with combined frontline chemotherapy with radiation consolidation. Our data demonstrate favorable outcomes in LS PBL with no improvements in outcome from aggressive frontline treatment including Hyper‐CVAD or auto‐SCT consolidation. Multivariate regression analysis (MRA) demonstrated improved PFS for patients receiving EPOCH based frontline therapy versus CHOP (HR: 0.23; p = 0.029). Frontline chemotherapy followed by radiation consolidation versus chemotherapy alone appeared to be associated with improved relapse and survival outcomes but did not show statistical significance in MRA.