HIV-Associated plasmablastic lymphoma in the era of highly active antiretroviral therapy: a single center experience of 21 patients.

OBJECTIVES 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. DESIGN Retrospective study. METHODS The morphologic, immunophenotypic and clinical features were reviewed in these HIV+ patients with PBL and univariate analysis was employed to determine the survival prognosis. RESULTS 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). CONCLUSIONS 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.