Plasmablastic Lymphoma of the Maxillary Sinus: Case Report of a Novel Treatment Approach of Concurrent Bortezomib and Intensity-Modulated Radiotherapy

Plasmablastic lymphoma (PBL) is an aggressive variant of diffuse large B-cell lymphoma and was initially described as affecting the oral cavity of patients with HIV. Recently, it has been better characterized through histopathology and case reports demonstrating that it may affect HIV-negative patients as well. In particular, elderly patients that have immunosenescence can develop PBL, and it may present in anatomic sites outside the oral cavity. Treatment typically consists of aggressive chemotherapy regimens, such as CHOP, EPOCH, or hyperCVAD; however, elderly patients may not be able to tolerate such intense regimens. We present a case of an elderly man with PBL of the maxillary sinus treated with a unique regimen of concurrent bortezomib and intensity-modulated radiotherapy (IMRT). This treatment produced a significant, durable tumor response and was well tolerated. Bortezomib with IMRT could be considered an alternative to more intense chemotherapy regimens, particularly in elderly patients with PBL, although prospective studies are needed to further test the safety and efficacy.