{
  "abstract": "Introduction: Plasmablastic lymphoma (PBL) is a rare, aggressive large B-cell lymphoma with plasmacytic differentiation. It is most frequently associated with human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV), although it also occurs in immunocompetent individuals. Owing to its rarity, no standard treatment has been established. Dose-adjusted EPOCH is commonly used, and the addition of daratumumab has shown promising results in small series and case reports. Case Report: A 48-year-old man with no history of transplantation or chronic immunosuppressive therapy presented with a 10-day history of progressive abdominal pain, abdominal distension and reduced oral intake. Computed tomography revealed an 11-cm mesenteric nodal mass. Positron emission tomography/computed tomography (PET/CT) demonstrated intensely hypermetabolic mesenteric and retroperitoneal lymphadenopathy (SUVmax 31). Histopathological examination of a mesenteric lymph node biopsy showed diffuse infiltration by plasmablastic cells expressing CD138, MUM1, CD38, focal CD79a, and CD3. The Ki-67 proliferation index was 95%, and c-MYC protein expression was detected in nearly 100% of tumor cells. CD20, PAX5, EBV, and HHV-8 were negative, favoring the diagnosis of PBL. HIV serology was negative, and no monoclonal protein was detected. Treatment was initiated with daratumumab plus dose-adjusted EPOCH. After the first cycle, the patient required hospitalization because of worsening abdominal pain and lactate dehydrogenase levels exceeding 2,500 U/L. Despite escalation to dose level 2 and completion of three chemotherapy cycles, computed tomography and PET/CT demonstrated unequivocal disease progression, with enlargement of the abdominal mass and new pancreatic, cervical, and thoracic involvement. Treatment was switched to teclistamab; however, the patient experienced rapidly progressive disease with severe organ dysfunction, lactate dehydrogenase levels exceeding 10,000 U/L, acute respiratory distress syndrome, refractory shock, and death. Discussion: This case expands the spectrum of EBV-negative PBL presenting as bulky abdominal lymphadenopathy in an immunocompetent adult. Although the absence of bone marrow evaluation prevented definitive exclusion of plasmablastic myeloma, the clinicopathological findings strongly favored PBL. Despite the incorporation of daratumumab into frontline dose-adjusted EPOCH, the patient developed primary refractory disease with rapid progression and fatal outcome. This report highlights the marked biological heterogeneity of PBL, the limitations of current treatment strategies, and the poor prognosis associated with primary refractory disease, emphasizing the need for more effective therapeutic approaches.",
  "abstract_shown": true,
  "affiliations": [
    "Universidade de Brasília (UnB), Brasília, DF, Brazil",
    "Hospital DF Star, Brasília, DF, Brazil"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Arthur Osório De Souza DIAS"
    },
    {
      "affs": [
        0
      ],
      "name": "Igor Gabriel Mendes QUIRIDO"
    },
    {
      "affs": [
        0
      ],
      "name": "Eduardo Rodrigues Marciano SILVA"
    },
    {
      "affs": [
        0
      ],
      "name": "Hélio Ramos Beserra JÚNIOR"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Eduarda Santos DE AMORIM"
    },
    {
      "affs": [
        1
      ],
      "name": "Fernando Sérgio Blumm FERREIRA"
    },
    {
      "affs": [
        1
      ],
      "name": "Flávia Xavier DIAS"
    },
    {
      "affs": [
        1
      ],
      "name": "Thaís Dourado Reis NÓBREGA"
    },
    {
      "affs": [
        1
      ],
      "name": "José Alberto Souza ABDON"
    },
    {
      "affs": [
        1
      ],
      "name": "Laís Contreiras BRITO"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0gxky0qf3p3vt.bib",
  "cited_by": 0,
  "doi": "10.1016/j.htct.2026.108523",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2531137926022704",
  "id": "0gxky0qf3p3vt",
  "issns": [
    "2531-1379",
    "2531-1387"
  ],
  "landing_url": "https://doi.org/10.1016/j.htct.2026.108523",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2730|Viral-associated cancers and disorders"
    ]
  ],
  "openalex": "W7223572558",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/0gxky0qf3p3vt.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:25Z",
      "native_id": "56429aa324df49f5aa3963e971c6b0c6",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.htct.2026.108523"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Viral-associated cancers and disorders",
      "subfield": "oncology"
    }
  ],
  "title": "PRIMARY REFRACTORY EPSTEIN-BARR VIRUS-NEGATIVE PLASMABLASTIC LYMPHOMA IN AN IMMUNOCOMPETENT ADULT: A CASE REPORT",
  "title_text": "PRIMARY REFRACTORY EPSTEIN-BARR VIRUS-NEGATIVE PLASMABLASTIC LYMPHOMA IN AN IMMUNOCOMPETENT ADULT: A CASE REPORT",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:25Z",
  "url": "https://research.draconitic.com/paper/0gxky0qf3p3vt",
  "venue": "Hematology, Transfusion and Cell Therapy",
  "versions": []
}