Breast Implant-Associated Anaplastic Large Cell Lymphoma: Treatment Experience In 53 Patients
Authors: Hart Alexandra , Lechowicz Mary Jo 
Published: October 2019

Purpose
Primary breast lymphomas are exceedingly rare; yet, recent reports continue to describe cases of breast implant-associated anaplastic large cell lymphoma (bi-ALCL). Every year over 250,000 women receive breast implants for cosmetic and reconstructive purposes making it necessary to explore the potential consequences of this emerging disease. Although the majority of cases follow an indolent clinical course, there have been several patient (pt) deaths reported, emphasizing the importance of investigation into variables associated with poor clinical outcomes. The purpose of this study is to describe pts diagnosed with bi-ALCL in order to enhance our management and treatment of this disease.

Methods
A review of the literature using search engines PubMed and MEDLINE were conducted using search terms “Anaplastic” AND “Lymphoma” AND “Breast,” “ALCL” AND “Breast” AND “Implants,” and “Anaplastic” AND “Breast” AND “Implant.” Articles were analyzed for accurate diagnoses excluding any duplicate pts. Two pts at our institution were reviewed using medical records. Univariate analysis determined significant associations (p<0.05). Multivariate analysis was performed when adequate pt data available.

Results
Sixty-two pts with bi-ALCL were identified from 29 publications, and two additional pts from our clinical practice were included. Eleven pts were excluded secondary to lack of treatment data. Clinical variables are summarized in Table 1. Twelve pts presented with extracapsular disease. Sixteen of 53 (23.1%) pts presented with a mass. Only nine pts (17%) were adequately staged for NHL. Twenty-one pts received a PET scan, and 9 received a bone marrow biopsy. Twenty one pts (39.6%) received surgery alone, 5 pts (9.4%) received surgery and radiation, 10 pts (18.9%) received surgery and chemotherapy, and 16 pts (30.2%) received surgery, chemotherapy, and radiation, and one pt (1.9%) received chemotherapy alone. CHOP (n=23, 43.4%) was the most common chemotherapy regimen. One pt received a bone marrow transplant (BMT) for upfront consolidative therapy. The median follow up is 15 months (3.6-90 months). Fifteen pts (28.3%) had recurrent disease. Eleven of those 15 pts (73.3%) were treated with salvage chemotherapy. Of those six received CHOP, two received ICE salvage, and three had an autologous BMT. Four patients died from their disease.
Univariate analysis demonstrated extracapsular disease extension is associated with increased risk for recurrence (p<.0001) and pt death (p=0.0008). B symptoms at presentation were associated with pt death (p=0.012). Pts presenting with a mass were not at increased odds for recurrence (p=0.36) but were at increased odds for death (p=0.043). Multivariate analysis did not show any significant difference in the odds for recurrence among different treatment modalities.

Conclusion
This represents the largest series of pts with bi-ALCL described to date. Our analysis confirms extracapsular disease extension is associated with increased risk for recurrence and patient death. Established protocols for NHL staging have not been routinely utilized. More detailed follow-up is necessary for prognostic data in this patient population. Future treatment guidelines will require a multi-disciplinary unified approach.

Disclosures:
No relevant conflicts of interest to declare.