TREATMENT AND OUTCOME OF BREAST IMPLANT-ASSOCIATED ANAPLASTIC LARGE CELL LYMPHOMA: A POpULATION-BASED COHORT STUDY IN THE NETHERLANDS
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare peripheral T-cell lymphoma (PTCL) associated with breast implants. The majority of patients present with stage I disease, often curable by resection. While cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) are commonly used in PTCL, the optimal treatment of AS BIA-ALCL remains unknown. This study aims to describe the treatment and outcome of patients with BIA-ALCL.
All BIA-ALCL patients up to 2023 were identified in the Netherlands Cancer Registry with survival follow-up through February 1st, 2024. Baseline characteristics, time between breast cancer (when applicable) and BIA-ALCL, treatment, response to treatment and survival outcomes were collected. Primary outcomes were progression-free survival (PFS) and overall survival (OS). OS was defined as the time interval between date of diagnosis of BIA-ALCL and all-cause death. PFS was defined as the time interval between diagnosis of BIA-ALCL and first date of relapse or all-cause death, whichever occurred first.
A total of 91 BIA-ALCL cases were identified with a median age of 55 years and a history of breast cancer in 36%. Ann Arbor stage I was frequently diagnosed (74%); stage II (13%) and stage IV (11%) were less common. First-line treatment of stage I patients consisted of tumor excision (88%) or chemotherapy (CT; 12%) with or without radiotherapy (RT; 7%). Of the stage II patients, 33% had resection only, and 67% CT. All stage IV patients received CT. Three patients were consolidated with autologous stem cell transplantation. Relapse, although uncommon in stage I (10%) and stage II (8%) disease, frequently occurred (60%) in stage IV disease. Following second-line treatment, all but one patient remained in remission. The 2-year PFS for stage I, stage II and stage IV was 89%, 83% and 50%, respectively. The 2-year OS was 98%, 92% and 90%, respectively. In univariable analyses, stage IV disease and treatment with CT were associated with a higher risk of relapse, but not with risk of mortality.
In BIA-ALCL, the long-term OS is excellent. However, the risk of relapse for patients with stage IV disease was high, although most patients received successful salvage therapy. There is a need for novel treatment strategies, particularly in stage IV disease.