Breast implant-associated anaplastic large cell lymphoma treated with definitive surgery

Optimal primary treatment for breast implant-associated anaplastic large cell lymphoma was definitive surgery with implant removal and total capsulectomy, according to research presented at the American Society of Plastic Surgery’s annual meeting in Boston.

Researchers conducted a retrospective review of all published cases from 1997 to 2015 and unpublished cases at M.D. Anderson Cancer Center of breast implant-associated anaplastic large cell lymphoma (BI-ALCL). They selected 27 patients with advanced disease, and contacted corresponding authors to update clinical follow-up. They compared treatment and outcomes of these patients to those of 65 control patients with BI-ALCL, but without aggressive characteristics.

The patients with advanced BI-ALCL included three with bilateral disease and 24 with lymph node metastases. Definitive surgery was used to treat 16 (59.3%) of patients with advanced BI-ALCL, limited surgery for 19 patients (70.4%); chemotherapy for 24 patients (88.9%); salvage chemotherapy for 11 patients (40.7%), radiation for 15 patients (55.6%) and autologous stem cell transplant for five patients (18.5%). No patients treated with definitive surgery died from BI-ALCL.

Complete remission was the outcome for 18 patients in the aggressive-variation cohort. Six patients died of ALCL, two died of unrelated disease and one patient is alive with ALCL. The rates of complete remission were 97% for the control group, 67% for the group with bilateral disease and 67% for those with lymph node metastases.

There was a longer time from diagnosis to definitive surgery and lower rate of definitive surgery in the aggressive-variant ALCL cohort compared with controls (21 vs. 8 months; P = .039; 59% vs. 88%; P = .004, respectively).

“Definitive surgery with implant removal and total capsulectomy appears to the optimal primary treatment for patients with BI-ALCL,” Charles E. Butler, MD, president-elect of The Plastic Surgery Foundation, said in a press release from the American Society of Plastic Surgeons. “Overall, this is a positive message for the rarity and treatability of the disease.”

Breast implants have reasonable safety and efficacy assurance, according the FDA in the release. The agency has urged physicians to report confirmed BI-ALCL cases.

“In conjunction with the [Plastic Surgery Foundation] and the FDA, we have been conducting research and analyzing the incidence of BI-ALCL to develop a better understanding and effectively educate patients and physicians,” study researcher Mark Clemens, MD, stated in the release. “The cutting-edge research … is evidence of our role working to bring together the most leading-edge clinical information to enhance patient satisfaction and lead the way in advancing patient safety.” – by Bruce Thiel

Reference:

Collins M. Characteristics and Treatment of Advanced Breast Implant-Associated Anaplastic Large Cell Lymphoma. Presented at: ASPS Plastic Surgery: The Meeting, Oct. 16-20, Boston.

Disclosure: Collins reports no relevant financial disclosures.