LETTER TO THE EDITOR Durable remission is achievable with localized treatment and reduction of immunosuppression in limited stage EBV-related plasmablastic lymphoma C. Phipps 1 & K. W. Yeoh 2 & Y. S. Lee 1 & C. Nagarajan 1 & S. Gopalakrishnan 1 & L. P. Ho 3 & W. Y. K. Hwang 1 & Y. T. Goh 1 & N. F. Grigoropoulos 1 Received: 10 July 2017 /Accepted: 16 August 2017 # Springer-Verlag GmbH Germany 2017 Dear Editor, We read with interest the recent letters by Fedele et al. [1] and Yanamandra et al. [2] where plasmablastic lymphoma was successfully treated with a combination of cytotoxic chemotherapy plus either bortezomib or lenalidomide. This is a rare disease, with no prospective randomised trials, and thus no defined standard of care [3]. We present the case of a 78-year-old man who gave a 2- week history of a painless enlarging exophytic mass on the upper left oral mucosa. Nineteen years prior to diagnosis, the patient had a cadaveric renal transplant. He was on long-term immunosuppression with prednisolone, ciclosporin, and azathioprine. He had longstanding type 2 diabetes and hypertension with advanced ischaemic heart disease. A 1 cm × 1 cm indurated hyperaemic mass was seen in the oral mucosa. The biopsy showed a diffuse lymphoid infiltrate with sheets of large cells having vesicular chromatin and prom- inent central nucleoli. Immunostaining for CD20 was neg- ative, cells were lambda light chain restricted, and EBER staining was positive. Cells were also positive for CD30 and CD3, but negative for other T cell markers. Clonal rearrangement was demonstrated by PCR for IGH and IGK, and not for T cell receptors. The diagnosis was thus made of EBV-related PBL. The full blood count was unremarkable and the marrow was uninvolved. EBV quantitative PCR showed 49,150 copies/mL (4.69 log) while HIV serology was negative. A staging PET-CT confirmed localized disease. Following discussion with the renal team, azathioprine was stopped and the ciclosporine dose was reduced. In view of the patient’s significant co-morbidities, the highly aggressive nature of PBL, and the paucity of clinical trial data, a palliative regimen of brentuximab vedotin (BV) [4] with RT was agreed upon. Despite an initial reduction in size, the mass was noted to be growing during the second cycle of BV which was thus discontinued. RT monothera- py was started and was tolerated well apart from mild mu- cositis. Only 16 of 20 planned fractions were delivered, total 32 Gy, because of an emergency admission to another hospital for a urinary tract infection. Following recovery, the oral mass had disappeared and the mucositis had re- solved (Fig. 1). The patient remains in complete remission 2 years after his diagnosis, albeit with persistence of circu- lating EBV DNA of 22,015 copies/mL (4.34 log). In contrast to the two recently published case reports of plasmablastic lymphoma, our patient had a very limited disease and was not fit for anthracycline-based treatment. Despite disease progression on BV, he achieved a durable complete response with radiotherapy only, highlighting that localized, non-intensive treatment combined with a reduction in immunosuppression can result in very good outcomes in selected cases. * N. F. Grigoropoulos nicholas.francis.grigoropoulos@singhealth.com.sg 1 Department of Haematology, Singapore General Hospital, Singapore, Singapore 2 Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore 3 Department of Pathology, Singapore General Hospital, Singapore, Singapore Ann Hematol DOI 10.1007/s00277-017-3109-4