Clinicopathologic features of the nine patients with primary diffuse large B cell lymphoma of the breast.
ABSTRACT Non-Hodgkin lymphomas of the breast are uncommon cancers that occur as either primary extranodal diseases or secondary localizations of a systemic disease. The term "primary breast lymphoma" (PBL) is used to define malignant lymphomas primarily occurring in the breast in the absence of previously detected lymphoma localizations. In this report, we analyzed nine patients with primary diffuse large B cell lymphoma (DLBCL) of breast.
Patients with newly diagnosed PBLs treated between 1997 and 2009 in five institutions were retrospectively evaluated.
The median age of the patients with PBL was 49 years (range 30-82 years), and four patients had left-sided and five had right-sided disease. All of the nine patients were classified as DLBCL. Five patients with DLBCL received chemotherapy followed by involved-field or elective-field radiotherapy and four received chemotherapy alone. Complete remission (CR) following primary treatment for all patients with PBL except for two cases was obtained. In two patients, recurrence occurred. At the median follow-up of 24.2 months, the 5-year OS rate was 76.2%. Univariate analysis indicated that age, ECOG PS, clinical stage, international prognostic index score, lactate dehydrogenase levels and the presence of B symptoms were not important prognostic factors in our study.
Our series contained a small sample size, but it is interesting because it included only DLBCL cases. However, definitive conclusions about treatment and follow-up options of patients cannot be made in such a small series of patients. There are very few reports of patients with PBL treated with R-CHOP rather than CHOP alone. The followup is probably still too short and sample size very few to know how R-CHOP compares with CHOP-treated patients in other series, but this is definitely worth looking at in more detail when reasonable median follow-up has been achieved and sample size are sufficient.
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ABSTRACT: To retrospectively evaluate the characteristics, natural history, results of treatment, and prognostic factors for patients diagnosed with primary breast lymphoma. Between 1973 and 1998, 25 women and 1 man with the diagnosis of primary breast non-Hodgkin lymphoma (PNHLB) were seen at Mayo Clinic Rochester and Mayo Clinic Scottsdale. Patient characteristics, treatment methods, and outcome were analyzed. The median follow-up for surviving patients was 6.6 years (range: 1.8-22.1 years). There were 11 low-grade NHL, 13 intermediate-grade NHL, and 2 high-grade NHL. Three patients underwent mastectomy while 23 had local excision. The Ann Arbor stage of disease included: Stage I-21 patients, Stage II-5 patients. Sixteen patients received radiation after surgery (15 after biopsy, 1 after mastectomy). Chemotherapy was given to 10 patients as part of the initial treatment. Four patients with low-grade disease were treated with excision only. The 5-year overall survival rate was 70% and relapse-free survival rate 42%, while local control rate was 75% and distant control rate 51%. Five-year survival and relapse-free survival rates for patients with low-grade disease were 91 and 61%, respectively. Three of four patients with low-grade disease treated with excision alone were free of local recurrence. For intermediate- and high-grade PNHLB, 5-year survival rate was 61% for those treated with chemotherapy, compared to 31% for those without chemotherapy (P = 0.35), and the 5-year relapse-free survival rates were 49%, compared to 0%, respectively (P = 0.0017). Three patients with intermediate- or high-grade disease developed central nervous system (CNS) dissemination. On univariate analysis, Ann Arbor stage was the only significant prognostic factor for survival (P = 0.0021). The management of PNHLB should be based on histologic grade. Patients with low-grade disease may be managed with local therapy alone. The role of chemotherapy in this group is unclear. Patients with intermediate- or high-grade disease have better outcome if chemotherapy is included. An unusual site of distant dissemination for these patients is the CNS. The only significant prognostic factor for survival is Ann Arbor stage.Journal of Surgical Oncology 06/2002; 80(1):19-25; discussion 26. · 2.64 Impact Factor
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ABSTRACT: Primary lymphoma of the breast (PBL) is a rare neoplasm, its outcome remains unclear compared to other lymphomas. We performed a retrospective study of 19 cases of high grade PBL. There were 17 Diffuse large B cell lymphoma (DLBCL) and 2 follicular and diffuse grade 3 lymphomas. Four patients were treated with local treatment only, 15 received chemotherapy including 11 treated with CHOP or ACVBP regimens followed by involved field radiotherapy. The actuarial survival for the whole population was 38%. Three of the 4 patients treated only with a local treatment died of their lymphoma. Three patients progressed on therapy and 5 relapsed in the first year of follow-up including 2 central nervous system recurrences. Among the 11 patients treated with chemotherapy, 2 died of their lymphoma. The overall survival of this subgroup was 73% (median follow-up of 57 months). We observed, like others in the literature, a better prognosis for lymphomas co-expressing Bcl6 and CD 10. The treatment should be based on the same modalities, but including a CNS prophylaxis even if poor prognosis factors are lacking. A radical mastectomy increases the risk of treatment failure and has to be avoided.Breast Cancer Research and Treatment 11/2005; 93(3):191-8. · 4.47 Impact Factor
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ABSTRACT: Standardized response criteria are needed to interpret and compare clinical trials and for approval of new therapeutic agents by regulatory agencies. The International Working Group response criteria (Cheson et al, J Clin Oncol 17:1244, 1999) were widely adopted, but required reassessment because of identified limitations and the increased use of [18F]fluorodeoxyglucose-positron emission tomography (PET), immunohistochemistry (IHC), and flow cytometry. The International Harmonization Project was convened to provide updated recommendations. New guidelines are presented incorporating PET, IHC, and flow cytometry for definitions of response in non-Hodgkin's and Hodgkin's lymphoma. Standardized definitions of end points are provided. We hope that these guidelines will be adopted widely by study groups, pharmaceutical and biotechnology companies, and regulatory agencies to facilitate the development of new and more effective therapies to improve the outcome of patients with lymphoma.Journal of Clinical Oncology 03/2007; 25(5):579-86. · 18.04 Impact Factor