Two Cases with CD-20 Negative Diffuse Large B-Cell Lymphoma and Literature Review

Case Report

Ann Hematol Oncol. 2016; 3(2): 1079.

Two Cases with CD-20 Negative Diffuse Large B-Cell Lymphoma and Literature Review

Miranda-Aquino T*, Pérez-Topete SE and Montemayor-Montoya JL

Department of Internal Medicine, Hospital Christus Muguerza, Mexico

*Corresponding author: Tomas Miranda Aquino, Department of Internal Medicine, Hospital Christus Muguerza, UDEM, 1ra Av 758 Jardines de Anáhuac, San Nicolás de los Garza, Nuevo León, México

Received: March 24, 2016; Accepted: May 18, 2016; Published: May 20, 2016


CD 20 negative diffuse large B-cell lymphoma is a very rare and aggressive neoplasm. We report two subtypes of this neoplasm: anaplastic lymphoma kinase positive diffuse large B-cell lymphoma and a plasmablastic lymphoma. These pathologies are very difficult to diagnose and treat. The first case was anaplastic lymphoma kinase positive diffuse large B-cell lymphoma, the patient received multiple schemes of chemotherapy with a torpid evolution and the patient died. The second case is a plasmablastic lymphoma, the patient was treated with infusional etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone dose-adjusted chemotherapy, the treatment was successful with complete remission and without relapses.

Keywords: CD 20 negative diffuses large B-cell lymphoma; Diffuse large B-cell lymphoma ALK positive; Plasmablastic lymphoma; Infusional DAEPOCH; CHOP-Bleo


ALK+DLBCL: Anaplastic Lymphoma Kinase Positive, Diffuse Large B-cell Lymphoma; PBL: Plasmablastic Lymphoma; CD20-: CD20 Negative; DLBCL: Diffuse Large B-cell Lymphoma; CHOPBleo: Cyclophosphamide, Daunorubicin, Vincristine, Prednisone and Bleomycin; IPI: International Prognostic Index; ICE: Ifosfamide, Carboplatin and Etoposide; PET: Positron Emission Tomography; CT: Computer Tomography; PET-CT: Positron Emission Tomography- Computed Tomography ; DA-EPOCH: Dose-adjusted Etoposide, Vincristine, Doxorubicin, Cyclophosphamide and Prednisone; LDH: Lactate Dehydrogenase; HIV: Human Immunodeficiency Virus; ALK: Anaplastic Lymphoma Kinase; CTLC-ALK; ALCL: Anaplastic Large cell Lymphoma; CD30; CD45; EMA: Epithelial Membrane Antigen; CD20; CD79a; PAX-5; CD138; CD4; MUM-1; IRF4; PFS: Progression-Free Survival; OS: Overall Survival; NCCN: National Comprehensive Cancer Network; Hyper CVAD: Hyperfractionated Cyclophosphamide, Vincristine, Doxorubicin and Dexamethasone alternating with cytarabine and methotrexate; CODOX-M/ IVAC: High dose Methrotrexate/Ifosfamide, Etoposide, and High dose Cytarabine; CHOP: Cyclophosphamide, Daunorubicin, Vincristine, Prednisone; GC: Non-germinal Center; SCT: Stem Cell Transplant; IMVP: Ifosfamide, Methotrexate and Etoposide; DHAP: Dexamethasone, high-dose Cytabine, cisplatin; PBSCT: Peripheral Blood Stem Cell Transplantation; PVDA: Prednisone, Vincristine, Doxorubicin and Asparaginase; R-CHOP: Rituximab- Cyclophosphamide, Daunorubicin, Vincristine, Prednisone; LNH96- 2002; BFM-90; LMB-89; LN: Lymph Node; NED: No Evidence of Disease


Anaplastic lymphoma kinase positive, diffuse large B-cell lymphoma (ALK+DLBCL) and plasmablastic lymphoma (PBL) are two very rare subtypes of diffuse large B-cell lymphoma (DLBCL). They are aggressive neoplasm of B cells [1], CD20 negative (CD20-) and with a high proliferation index [2], with poor response to current therapies [3]. We report two cases with this diagnosis.

Case 1

A 44-year-old man without past medical history was diagnosed with ALK+DLBCL with plasmacytoid differentiation (Figure 1A,1B) in the context of supraclavicular lymphadenopathy and B symptoms. An abdominal computer tomography (Figure 2) revealed splenomegaly and retroperitoneal lymphadenopathy. The bone marrow biopsy was negative for malignant cell infiltration; clinical stage IIIA, and an international prognostic index (IPI) of 3 points. Six cycles of cyclophosphamide, daunorubicin, vincristine, prednisone and bleomycin (CHOP-Bleo) chemotherapy was indicated, but without improvement. A second line chemotherapy consisting of three cycles of ifosfamide, carboplatin and etoposide (ICE) was administered. At the final of the chemotherapy the patient had symptomatic improvement but a positron emission tomography (PET) scan showed lymphoma activity. A stem cell collection for autologous stem cell transplant (SCT) was unsuccessful; therefore, 25 sessions of retroperitoneal and spleen radiotherapy were given.