Intrathecal mehthotrexate and Velcade for plasmablastic lymphoma – pro
Plasmablastic lymphoma (PBL) is a clinicopathological entity that was initially described in 1997 and is now considered a distinct subtype of diffuse large B-cell lymphoma (DLBCL) seen more commonly in patients with HIV infection.
Castillo et al writes: “Only a handful of cases have reported the use of intrathecal agents to minimize the risk of central nervous system involvement. However, given the high proliferation rate of PBL, the strong association with HIV infection, the high rate of extranodal involvement, and the presence of MYC translocations, we believe that intrathecal prophylaxis should be considered in most patients with PBL.” Ther are no guideliens supporting this practice and it remains a personal opinion of the author. As such, it cannot be said to be the SOC for this diagnosis.
As of 2013, there were only 5 cases on the use fo Velcade for plasmablastic lymphoma( Saba et al). The authors concluded: ” We conclude that bortezomib resulted in rapid and dramatical responses regardless of the line of therapy. Although most of these responses were not sustained, bortezomib represents a new therapeutic option for PBL that should be further explored in larger clinical trials.”. Such trials have not been done.
Jorge J. Castillo, Michele Bibas and Roberto N. Miranda, The biology and treatment of plasmablastic lymphoma. Blood 2015 125:2323-2330
Christine Saraceni et al, Plasmablastic lymphoma of the maxillary sinus in an HIV-negative patient: a case report and literature review SpringerPlus (2013) 2: 142.
Saba N.S. et al, Bortezomib in Plasmablastic Lymphoma: A Case Report and Review of the Literature. Onkologie 2013;36:287–291