Prognostic factors in chemotherapy-treated patients with HIV-associated Plasmablastic lymphoma

Oncologist. 2010;15(3):293-9. doi: 10.1634/theoncologist.2009-0304. Epub 2010 Feb 18.


Background: Plasmablastic lymphoma (PBL) is a variant of diffuse large B-cell lymphoma commonly seen in the oral cavity of HIV-infected individuals. PBL has a poor prognosis, but prognostic factors in patients who have received chemotherapy have not been adequately evaluated.

Methods: An extensive literature search rendered 248 cases of PBL, from which 157 were HIV(+). Seventy cases with HIV-associated PBL that received chemotherapy were identified. Whenever possible, authors of the original reports were contacted to complete clinicopathological data. Univariate analyses were performed calculating Kaplan-Meier estimates and compared using the log-rank test.

Results: The mean age was 39 years, with a male predominance. The mean CD4(+) count was 165 cells/mm(3). Advanced clinical stage was seen in 51% and extraoral involvement was seen in 43% of the cases. The expression levels of CD20 and Epstein-Barr virus-encoded RNA were 13% and 86%, respectively. The overall survival duration was 14 months. In a univariate analysis, early clinical stage and a complete response to chemotherapy were associated with longer survival. There was no apparent difference in survival with regimens more intensive than cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP).

Conclusions: Patients with HIV-associated PBL have a poor prognosis. Prognosis is strongly associated with achieving a complete clinical response to CHOP or CHOP-like chemotherapy. The role of more intensive regimens is currently unclear. Further research is needed to improve responses using novel therapeutic agents and strategies.

MeSH terms

  • Adolescent
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Child
  • Child, Preschool
  • Cyclophosphamide / administration & dosage
  • Doxorubicin / administration & dosage
  • Female
  • HIV Infections / complications*
  • HIV Infections / pathology
  • Humans
  • Lymphoma, AIDS-Related / drug therapy*
  • Lymphoma, AIDS-Related / pathology
  • Lymphoma, Large-Cell, Immunoblastic / drug therapy*
  • Lymphoma, Large-Cell, Immunoblastic / pathology
  • Lymphoma, Large-Cell, Immunoblastic / virology*
  • Male
  • Middle Aged
  • Prednisone / administration & dosage
  • Prognosis
  • Survival Analysis
  • Treatment Outcome
  • Vincristine / administration & dosage
  • Young Adult


  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol