In-situ ALK-negative anaplastic large cell lymphomas associated with breast implant (i-ALCLs) have an indolent clinical course and typically remain free of disease after the implant is removed, while infiltrative i-ALCLs could have a more aggressive clinical course that might necessitate additional therapy to implant removal, a new study published online ahead of print in the journal Annals of Oncology has shown.1
i-ALCL has recently been recognized as a distinct type of cancer after a study of 300 breast lymphomas comprising 25 peripheral T-cell lymphomas showed that ALK-negative ALCL was the most common and that all ALK-negative ALCLs were associated with breast implants.
For this retrospective analysis, researchers sought to analyze immune-morphologic features, molecular data, and clinical outcomes of 19 patients with i-ALCL, whose data were collected from different institutions through Lymphopath. The median age of the patients was 61 years and the median length between breast implant and i-ALCL was 9 years.
Seventeen of the 19 patients underwent implant removal with 10 patients receiving additional treatment based on mostly CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CHOP-like chemotherapy regimens and 1 receiving additional therapy based on irradiation. Two patients received CHOP alone or ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) following radiation without implant removal.
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Researchers identified 2 clinical presentations. The first, in-situ i-ALCL, had anaplastic cell proliferation confined to the fibrous capsule, while infiltrative –ALCL had pleomorphic cells massively infiltrating adjacent tissue with eosinophils and sometimes Reed-Sternberg-like cells mimicking Hodgkin lymphoma.
Researchers found that after a median of 18 months of follow-up, the 2-year overall survival for in-situ i-ALCL was 100% compared with 52.5% for infiltrative i-ALCL.
- Laurent C, Delas A, Gaulard P, et al. Breast implant associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes [published online ahead of print on November 23, 2015]. Ann Oncol. doi: 10.1093/annonc/mdv575.