HIV-related plasmablastic lymphoma with different therapeutic approaches : two case reports

Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell non-Hodgkin lymphoma often associated with HIV infection or immunodeficiency. No standard treatment has been established because of its rarity and the limited clinical data available. Experimental therapeutic approaches include bortezomib (a proteasome inhibitor) and daratumumab [a human IgG1k anti-CD38 monoclonal antibody (mAb)]. Herein, we present two cases of HIV-positive patients with PBL treated at the University Hospital in Cracow whose disease was refractory to first-line and subsequent therapies. Both patients were diagnosed with HIV infection and plasmablastic lymphoma simultaneously. The first patient was treated with the DA-EPOCH (dose-adjusted etoposide, vincristine, doxorubicin, cyclophosphamide) chemotherapy regimen as first-line therapy. Secondary to disease progression after first-line treatment, DHAP (dexamethasone, high-dose cytarabine, cisplatin) chemotherapy plus bortezomib was introduced, and, because of further progression, third-line treatment with a daratumumab-based DRd (daratumumab, lenalidomide, dexamethasone) regimen was initiated. The second patient received the DA-EPOCH regimen as first-line therapy. Following progression after the fifth cycle of DA-EPOCH, ICE (ifosfamide, carboplatin, etoposide) plus bortezomib was introduced as second-line therapy. These cases underscore the aggressive course of PBL in the setting of HIV infection and highlight the need for novel therapeutic approaches to improve outcomes.