A Rare Case of Plasmablastic Lymphoma With Difficult Diagnosis and Treatment in a Cardiac Transplant Patient

TL;DR

A rare case of plasmablastic lymphoma in a cardiac transplant patient is described, highlighting diagnostic challenges and treatment approaches.

Contribution

This paper presents a unique clinical case of plasmablastic lymphoma in a post-transplant patient with complex diagnostic and therapeutic considerations.

Findings

Plasmablastic lymphoma shares features with plasmacytic myeloma, leading to diagnostic uncertainty.

Treatment with a combination of rituximab, EPOCH, bortezomib, and daratumumab was used in this patient.

Post-transplant lymphoproliferative disorder can present with overlapping features of multiple lymphoid malignancies.

Abstract

Plasmablastic lymphoma (PBL) is a rare lymphoproliferative disease that can affect immunocompromised post-transplant patients. Patients with positive human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) status are at high risk. PBL shares many immunological markers and cytological characteristics with plasmacytic myeloma, which can lead to uncertainty and delay in diagnosis. However, myeloma typically involves the bone marrow, and the presence of other laboratory findings in myeloma, such as paraproteinemia, renal disease, and hypercalcemia, along with careful review of the biopsy, may help to distinguish between the two conditions. Treatment options are limited with poor prognosis and survival; however, intensive chemotherapy regimens such as EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) are often used, sometimes in combination with agents that are being traditionally used in the treatment of myeloma, such as bortezomib and daratumumab. Here, we describe the case of a 54-year-old male patient who developed post-transplant lymphoproliferative disorder (PTLD) after undergoing cardiac transplantation with biopsy findings suspicious for both PBL and plasmacytic myeloma and treated with rituximab plus the EPOCH regimen, bortezomib, and daratumumab.

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