Plasmablastic lymphoma: 2024 update on diagnosis, risk stratification, and management

Am J Hematol. 2024 Aug;99(8):1586-1594. doi: 10.1002/ajh.27376. Epub 2024 May 20.

Abstract

Disease overview: Plasmablastic lymphoma (PBL) is a rare CD20-negative aggressive lymphoma with a poor prognosis under standard treatment options. Though PBL is associated with human immunodeficiency virus infection and other immunosuppressed states, it can also affect immunocompetent individuals.

Diagnosis: The diagnosis requires a high clinical suspicion and pathological confirmation. EBER expression and MYC gene rearrangements are frequently detected. The differential diagnosis includes EBV+ diffuse large B-cell lymphoma, extracavitary primary effusion lymphoma, ALK+ DLBCL, and HHV8+ large B-cell lymphoma, among others.

Risk stratification: Age ≥60 years, advanced clinical stage, and high intermediate and high International Prognostic Index scores are associated with worse survival.

Management: Combination chemotherapy regimens, such as EPOCH, are recommended. The addition of bortezomib, lenalidomide, or daratumumab might improve outcomes. Including PBL patients and their participation in prospective clinical trials is warranted.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal
  • Antineoplastic Combined Chemotherapy Protocols* / therapeutic use
  • Bortezomib / administration & dosage
  • Bortezomib / therapeutic use
  • Cyclophosphamide / therapeutic use
  • Diagnosis, Differential
  • Disease Management
  • Doxorubicin / administration & dosage
  • Doxorubicin / therapeutic use
  • Etoposide
  • Humans
  • Lenalidomide / administration & dosage
  • Lenalidomide / therapeutic use
  • Lymphoma, Large B-Cell, Diffuse / diagnosis
  • Lymphoma, Large B-Cell, Diffuse / drug therapy
  • Lymphoma, Large B-Cell, Diffuse / genetics
  • Lymphoma, Large B-Cell, Diffuse / therapy
  • Middle Aged
  • Plasmablastic Lymphoma* / diagnosis
  • Plasmablastic Lymphoma* / drug therapy
  • Plasmablastic Lymphoma* / therapy
  • Prednisone / therapeutic use
  • Prognosis
  • Risk Assessment
  • Vincristine / administration & dosage
  • Vincristine / therapeutic use

Substances

  • Cyclophosphamide
  • Doxorubicin
  • Vincristine
  • Prednisone
  • Lenalidomide
  • Bortezomib
  • daratumumab
  • Antibodies, Monoclonal
  • Etoposide

Supplementary concepts

  • EPOCH protocol