Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Long-Term Follow-Up of 60 Patients

• Authors: Roberto N. Miranda, University of Texas MD Anderson Cancer Center; Tariq N. Aladily, University of Jordan; H. Miles Prince, Peter MacCallum Cancer Center, Melbourne; Rashmi Kanagal-Shamanna, University of Texas MD Anderson Cancer Center; Daphne de Jong, Vrije Universiteit Amsterdam; Luis E. Fayad, University of Texas MD Anderson Cancer Center; Mitual B. Amin, Oakland University; Nisreen Haideri, Saint Luke's Cancer Institute, Kansas City; Govind Bhagat, Columbia University; Glen S. Brooks, Tufts University; David A. Shifrin, Advocate Group Medical Plastic Surgery, Oak Lawn; Dennis P. O'Malley, Clarient Laboratories/GE Healthcare; Chan Y. Cheah, Peter MacCallum Cancer Center, Melbourne; Carlos E. Bacchi, Laboratorio de Patalogia Bacchi em Botucatu. Brazil; Gabriela Gualco, Laboratorio de Patalogia Bacchi em Botucatu. Brazil; Shiyong Li, Emory University; John A. Keech Jr., MultiCare Health Systems, Tacoma (WA); Ephram P. Hochberg, Harvard University; Matthew J. Carty, Brigham & Women's Hospital; Summer E. Hanson, University of Texas MD Anderson Cancer Center; Eid Mustafa, Plastic & Reconstructive Surgery, Wichita Falls; Steven Sanchez, Pathology Associates of Tyler (TX); John T. Manning Jr., University of Texas MD Anderson Cancer Center; Zijun Y. Xu-Monette, University of Texas MD Anderson Cancer Center; Alonso R. Miranda, University of Houston; Patricia Fox, University of Texas MD Anderson Cancer Center; Roland L. Bassett, University of Texas MD Anderson Cancer Center; Jorge J. Castillo, Brown University; Brady E. Beltran, Hospital Nacional Edgardo Rebagliati Martins, Peru; Jan Paul de Boer, Netherlands Cancer Institute; Zaher Chakhachiro, American University of Beirut; Dongjiu Ye, Bioreference Laboratories, Elmwood Park (NJ); Douglas Clark, New Mexico Cancer Center; Ken H. Young, University of Texas MD Anderson Cancer Center; L. Jeffrey Medeiros, University of Texas MD Anderson Cancer Center
• Journal Title: Journal of Clinical Oncology
• Volume: Volume 32, Number 2
• Publisher: American Society of Clinical Oncology | 2014-01-10, Pages 114-120
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1200/JCO.2013.52.7911
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Health Sciences, Radiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Capsule; Breat-Implant; Large-Cell Lymphoma

Abstract

Purpose Breast implant-associated anaplastic large-cell lymphoma (ALCL) is a recently described clinicopathologic entity that usually presents as an effusion-associated fibrous capsule surrounding an implant. Less frequently, it presents as a mass. The natural history of this disease and long-term outcomes are unknown. Patients and Methods We reviewed the literature for all published cases of breast implant-associated ALCL from 1997 to December 2012 and contacted corresponding authors to update clinical follow-up. Results The median overall survival (OS) for 60 patients was 12 years (median follow-up, 2 years; range, 0-14 years). Capsulectomy and implant removal was performed on 56 of 60 patients (93%). Therapeutic data were available for 55 patients: 39 patients (78%) received systemic chemotherapy, and of the 16 patients (28%) who did not receive chemotherapy, 12 patients opted for watchful waiting and four patients received radiation therapy alone. Thirty-nine (93%) of 42 patients with disease confined by the fibrous capsule achieved complete remission, compared with complete remission in 13 (72%) of 18 patients with a tumor mass. Patients with a breast mass had worse OS and progression-free survival (PFS; P = .052 and P = .03, respectively). The OS or PFS were similar between patients who received and did not receive chemotherapy (P = .44 and P = .28, respectively). Conclusion Most patients with breast implant-associated ALCL who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants.