Most Breast Implant–Associated Lymphomas Have Indolent Clinical Course

A case series of 29 patients with a rare peripheral T-cell lymphoma that is associated with breast implants found that most cases have an indolent clinical course, though a minority are more aggressive. The malignancy is known as breast implant–associated anaplastic large cell lymphoma (BIA-ALCL).

“The specific relationship suggests an oncogenic mechanism directly linked to the presence of the prosthesis and its components, and therefore present an opportunity to analyze how implants might influence the immune system, leading to the development of malignant clones,” wrote study authors led by Corinne Haioun, MD, of CHU Henri Mondor, in Créteil, France, in a poster. The poster (abstract 7554) was presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 1–5 in Chicago.

The investigators examined the first 29 cases of BIA-ALCL included in the French Lymphopath network, which includes a total of 59,356 lymphomas registered since 2010. The aim was to describe the clinical and histopathological characteristics of these patients.

The median age of the 29 patients included was 62 years. More than half the patients received the breast implants for breast cancer reconstruction (51.7%); 34.5% received them for cosmetic reasons, and 13.8% for other reasons including granulomatosis, posttraumatic necrosis, and others. All but 1 patient received at least one textured implant (96.6%), and all but 3 received at least one silicon implant (89.7%).

The interval from first implant to lymphoma diagnosis was 10.2 years. Most patients presented with effusion only (72.4%); smaller numbers presented with mass only (10.3%), effusion and mass (13.8%), and one presented with neither effusion nor mass (3.4%). Twenty-two patients (76%) presented with Ann Arbor stage IE/IIE, and 7 patients (24%) presented with stage IV disease.

Twelve patients (42.9%) received first-line CHOP or CHOP-like regimens. Twenty-seven patients underwent surgery (93.1%). Among those who did undergo surgery, a complete capsulectomy was performed in 85.2%.

Twenty-three patients (73.3%) had a complete response to therapy, while 4 patients (13.8%) had progressive disease; 2 were not evaluated for response.

After 2 years of median follow-up, 23 patients remained alive and free of evolutive disease. Four patients with tumor mass presentation died from lymphoma progression, after 4, 7, 10, and 16 months.

“In situ BIA-ALCLs enrolled in our series have mostly an indolent clinical course and remain in complete remission mainly after implant removal,” the study authors wrote. “Infiltrative BIA-ALCLs have a more aggressive clinical course.” They suggested that multiple implants and/or a past history of breast cancer could contribute to the occurrence of BIA-ALCL.