Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients

Roberto N Miranda, Tariq N Aladily, H Miles Prince, Rashmi Kanagal-Shamanna, Daphne de Jong, Luis E Fayad, Mitual B Amin, Nisreen Haideri, Govind Bhagat, Glen S Brooks, David A Shifrin, Dennis P O'Malley, Chan Y Cheah, Carlos E Bacchi, Gabriela Gualco, Shiyong Li, John A Keech, Ephram P Hochberg, Matthew J Carty, Summer E Hanson, Eid Mustafa, Steven Sanchez, John T Manning, Zijun Y Xu-Monette, Alonso R Miranda, Patricia Fox, Roland L Bassett, Jorge J Castillo, Brady E Beltran, Jan Paul de Boer, Zaher Chakhachiro, Dongjiu Ye, Douglas Clark, Ken H Young, L Jeffrey Medeiros
Journal of Clinical Oncology 2014 January 10, 32 (2): 114-20

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.

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