Clinical characteristics and prognosis analysis of 13 cases of newly diagnosed plasmablastic lymphoma

Objective To explore the clinical characteristics, treatment, and prognosis of patients with newly diagnosed plasmablastic lymphoma (PBL). Methods The clinical data of 13 newly diagnosed PBL patients admitted to Chongqing University Cancer Hospital from January 2013 to June 2024 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier survival curve and Log-rank test. Univariate and multivariate Cox regression model analyses were used for analyzing prognostic factors. Results ①The number of male and female cases was 10:3. The median age was 52.15 (26-78) years old. Six cases (46.1%) had extranodal organ involvement as the initial symptom, including 3 cases (23.1%) of oral and maxillofacial region. There were 7 cases (53.9%) in Ann-Arbor stage Ⅰ~Ⅱ and 6 cases (46.1%) in stage Ⅳ. Six cases (46.1%) had B symptoms. Two cases (15.3%) had an IPI score ≥3. Nine cases (69.2%) had elevated peripheral blood EB-DNA detection. One case had bone marrow invasion (7.7%), and one case had central nervous system invasion. ②All patients expressed CD38, CD138, and MUM-1. B-cell markers such as PAX-5 and Bcl-6 were occasionally seen. Six cases (46.2%) had positive EBER detection. ③All 13 patients received chemotherapy, and 3 cases received combined radiotherapy. The median follow-up was 48.31 (16-141) months. The median OS was 33.08 (11-79) months, and the median PFS was 25.62 (2-79) months. ④Seven cases received the EPOCH regimen, 6 cases received the CHOP or CHOP-like regimen. Five cases received new drugs in the first-line treatment (3 cases combined with bortezomib, 1 case combined with lenalidomide, and 1 case combined with a PD-1 inhibitor). Three cases received combined local radiotherapy. After first-line treatment, 5 cases had a CR evaluation, 6 cases had a PR evaluation, 1 case had SD, and 1 case had NA. ⑤The best efficacy evaluation: 5 cases had CR, 7 cases had PR, and 1 case had NA. The combination of new drugs and autologous stem cell transplantation (ASCT) in the first-line treatment had obvious benefits, but the use of new drugs such as Lenalidomide and Selinexor in the third-line and above had poor effects. ⑥Kaplan-Meier analysis showed that the overall survival of PBL was significantly related to IPI score 3-5, B symptoms, and male gender (P<0.05). According to univariate COX regression analysis, for newly diagnosed PBL, anemia (≤120g/L) and IPI score 3-5 were factors for poor prognosis of PFS. IPI score 3-5 was a factor for poor prognosis of OS. Combined HIV infection had no significant impact on prognosis. Conclusions For PBL treated through standardized treatment, the impact of HIV infection on prognosis can be overcome. At initial diagnosis, anemia (≤120g/L) and IPI score 3-5 are factors for poor prognosis of PFS in PBL. IPI score 3-5 is a factor for poor prognosis of OS. The first-line treatment choice of combining new drugs (Bortezomib, Lenalidomide, PD-1 inhibitor) and ASCT is expected to improve the prognosis of PBL.