The Role of Intensive Chemotherapy and Radiotherapy in Plasmablastic Lymphoma: Optimizing Survival Outcomes

Background: Plasmablastic Lymphoma (PBL), a rare and aggressive subtype of non-Hodgkin's lymphoma, often arises in immunosuppressed patients, including those with HIV or undergoing immunosuppressive treatments. Due to its rarity, a standardized approach to its management has been elusive. Our study evaluated the effectiveness of intensive chemotherapy and radiotherapy on survival outcomes in patients with PBL. Methods: We conducted a comprehensive analysis using a pooled database, encompassing demographic data, molecular characteristics, and treatment responses of a retrospective cohort with confirmed PBL cases. Kaplan-Meier survival curves were constructed. Cox proportional hazards model and Log-rank tests were used to assess the survival impacts of various treatments. Results: The study cohort comprised 300 confirmed PBL cases with a median age of 49. It predominantly consisted of males (M:F ratio of 2.7). Approximately 51% were diagnosed at advanced stages (III/IV), and 62% had an immunocompromised status, 47% due to HIV. Analysis showed a median overall survival (OS) and disease-free survival (DFS) of 25 and 15 months, respectively. Significant factors influencing OS included bone marrow, liver, lung/pleura, and upper GI tract involvements; all were associated with poorer outcomes. Conversely, early-stage <2 disease (p<0.0001), head and neck involvement (p=0.0001), and attaining CR (p<0.0001) were linked to better survival. Compared to no treatment, chemotherapy (CT) and stem cell transplant had incrementally better OS (2 vs. 27 vs. NR months, p<0.0001). Patients who underwent frontline intensive chemotherapy (ICT) had a superior OS compared to those treated with CHOP-like or myeloma protocols in decreasing order (p<0.0001). ICI survival benefit persisted when analyzed by early vs. advanced stages (p=0.0009). Radiotherapy (RT) improved OS when added to intensive and non-intensive CT (p=0.03). However, upon further analysis, RT benefits were restricted to those with early stages (I&II) H&N PBL (NR vs. 27mo; p=0.0008). Conclusion: Our findings support an aggressive chemotherapy approach in managing Plasmablastic Lymphoma with the addition of radiotherapy in H&N early-stage disease. This approach maximizes survival and highlights the importance of tailored treatment strategies based on disease stage and location.