Article

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

H. Miles Prince, Chan Cheah, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
Journal of Clinical Oncology (Impact Factor: 18.43). 12/2013; 32(2). DOI: 10.1200/JCO.2013.52.7911
Source: PubMed

ABSTRACT

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.
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.
The median overall survival (OS) for 60 patients was 12 years (median follow-up, 2 years; range, 0-14 years). 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).
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.

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    • "There are two distinct clinical presentations with disparate clinical behavior: (1) the more common and indolent seroma-type in which fluid containing malignant lymphocytes accumulates between the implant and the surrounding fibrous capsule, (2) the less frequent but more aggressive mass lesion which is usually accompanied by seroma [77]. Miranda et al. recently reported the largest experience of BIA-ALCL, comprising 60 women (42 seroma-type , 18 mass-type), with median age 52 years [54]. The median time from implant insertion to diagnosis of BIA-ALCL was 9 (range 1–32) years and 93% had localized disease (83% stage I, 10% stage II). "
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