Abstract: Characteristics and Treatment of Patients with Breast Implant-Associated Anaplastic Large Cell Lymphoma Presenting with Aggressive Features (Plastic Surgery 2015)

Sunday, October 18, 2015: 2:20 PM

Mark W. Clemens, MD , Plastic Surgery, MD Anderson Cancer Center, The University of Texas, Houston, TX

Meredith S. Collins, MD , Plastic Surgery, M.D. Anderson Cancer Center, Houston, TX

Charles E Butler, MD , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Kelly K. Hunt, MD , Surgical Oncology, M.D. Anderson Cancer Center, Houston, TX

Jeffrey Madeiros, MD , Hematopathology, MD Anderson Cancer Center, Houston, TX

Michelle Fanale, MD , Lymphoma, MD Anderson Cancer Center, Houston, TX

Jun Liu, MD, PhD , Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX

Roberto N Miranda, MD , Hematopathology, MD Anderson Cancer Center, Houston, TX

Presentation PDF file

Background:

Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a T-cell lymphoma arising around breast implants. Although initially considered as an “indolent” lymphoma, a subset of patients display more insidious disease marked by persistent and recurrent growth refractory to treatment.^1,2,3,4 The purpose of this study is to evaluate cases of BI-ALCL presenting with aggressive features: bilateral disease, lymph node involvement, and/or death of disease.

Methods:

A retrospective review of all published cases from 1997 to 2015 and unpublished cases at our institution of BI-ALCL was performed and patients with aggressive features were compared to patients without aggressive features. Patient demographics, treatment, and outcomes were evaluated.

Results:

We identified 27 patients with aggressive features and included bilateral disease (n=3), lymph node involvement (LNI, n=24), and death of disease (n=6). 65 patients without aggressive features were selected as a comparative group. Treatment types for the aggressive-variant BI-ALCL patients were as follows: definitive surgery, n=16 (59.3%); limited surgery, n=19 (70.4%); chemotherapy, n=24 (88.9%); salvage chemotherapy, n=11 (40.7%); radiation, n=15 (55.6%); autologous stem cell transplant, n=5 (18.5%). The rates of complete remission (CR) were 18/27 (66.7%) for patients with aggressive features and 63/65 (97%) for patients without aggressive features (p<0.0001). No patients who received definitive surgery died of disease at last follow up. The rates of CR for comparative group, bilateral group and LAD group were: 63/65 (97%), 2/3 (67%, p<0.001) and 16/24(67%, p=0.128), respectively. Patients with aggressive features had longer time from diagnosis to definitive surgery (21 vs. 8 months, p=0.039) and had less frequency of definitive surgery (59% vs. 88%, p=0.004).

Conclusions:

Definitive surgery with implant removal and total capsulectomy results in improved survival in patients with BI-ALCL, including those presenting with aggressive features. A delay in appropriate treatment of patients with BI-ALCL can result in progression to aggressive features such as lymphadenopathy. The benefit of adjuvant chemotherapy and radiation for patients with aggressive-variant ALCL is yet to be defined.

28018 Characteristics and Treatment of Patients with Breast Implant-Associated Anaplastic Large Cell Lymphoma Presenting with Aggressive Features