LETTER TO THE EDITOR Plasmablastic lymphoma: successful management with CHOP and lenalidomide in resource constraint settings Uday Yanamandra 1 & Kamal Kant Sahu 1 & Nidhi Jain 1 & Gaurav Prakash 1 & Uma Saikia 2 & Pankaj Malhotra 1 Received: 8 April 2016 /Accepted: 15 June 2016 # Springer-Verlag Berlin Heidelberg 2016 Dear Editor, We read with great pleasure the recent article by Fedele et al. in your esteemed journal [ 1 ]. We present a case of plasmablastic lymphoma (PBL) in an HIV-positive individual being successfully treated with CHOP-lenalidomide (cyclo- phosphamide, daunorubicin, vincristine, prednisolone) therapy. A 40-year-old female with an average monthly in- come of 50USD was diagnosed with HIV a year back (presenting CD 4 -count: 504/ μL, thus not started on combined antiretroviral therapy (cART)). She presented with rapidly increasing swelling involving left infraorbital/maxillary region of 2 months duration lead- ing to visual obscuration and nasal stuffiness (Fig.1a, b). There was no history of diplopia, proptosis, or B symptoms (weight loss/fever). Trucut biopsy and immunohistochemistry confirmed the diagnosis of PBL (Fig.2a–f). Staging contrast-enhanced computed tomog- raphy (CECT) showed isolated huge mass involving left maxilla, frontal sinus, and invasion of the inferior orbital plate. Cerebrospinal fluid (CSF) studies were negative for any malignant involvement. The patient was staged as I-AEX (modified Ann Arbor staging) with a prognostic IPI scoring of 2/5 (international prognostic index). Evaluation for opportunistic infection including workup for EBV and HHV-8 by serological tests was negative. The possibility of plasma cell dys- crasia was ruled out based on IMWG criteria. She started on CHOP-lenalidomide therapy (CHOPq21d at standard doses with 25 mg lenalidomide q18/21d). cART was started despite CD4 > 500/ μL considering PBL as an AIDS defining illness. Patient tolerated chemotherapy and cART well with no adverse reactions. She had a remarkable improvement in swelling by 2nd cycle (Fig.1c, d) and further decrease by 4th cycle of chemotherapy (Fig. 1e, f ). An interim evaluation by CECT post 4th cycle showed 90 % reduction in the size of the tumour. She was also given CSF prophylaxis with intrathecal methotrexate therapy in each cycle (Fig. 3a, b ). At the end of 6 cycles of chemo- therapy, patient attained complete remission on PET im- aging. She continued on lenalidomide maintenance (15 mg 21/28d × 3 cycles) at the end of induction. The clinical course of PBL is usually aggressive with median overall survival of 15 months and 3-year OS rate of 25 % [1–4]. As very well highlighted by Fedele et al., usually, CHOP is considered inadequate and suggested intensive regimens including CODOX-M/ IVAC, hyper-CVAD, and EPOCH based on patient tol- erability. Continuation of HAART during chemotherapy is recommended in cases of HIV co-infection. Recently, * Pankaj Malhotra hematpgi@gmail.com 1 Department of Internal Medicine (Clinical Hematology Division), PGIMER, Chandigarh 160012, India 2 Department of Histopathology, P.G.I.M.E.R, Chandigarh. U.T 160012, India Ann Hematol DOI 10.1007/s00277-016-2732-9