Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Long-Term Follow-Up of 60 Patients

Abstract

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.

Early lymphoid lesions: conceptual, diagnostic and clinical challenges

“…107 In a recent review, no statistical difference was identified between indication for breast-implants (cosmetic vs. reconstructive surgery), laterality and type of implant (saline vs. silicone). 108 The median time to diagnosis of ALCL after implantation was nine years. Patients most often presented with a peri-implant effusion (seroma) or less commonly with a mass adjacent to the effusion.…”

“…Molecular analysis showed clonal TCRG rearrangements in 28 of 29 cases tested. 108 Clinical management was variable and ranged from capsulectomy, mastectomy, radiotherapy, chemotherapy and autologous stem cell transplantation. While median follow-up periods are short (2 years), 93% of patients without a mass had a complete remission compared to 72% of patients with a mass.…”

“…Interestingly, adjuvant chemotherapy did not significantly improve clinical outcome and remission rates were much better than systemic ALK-negative ALCL. 108 If there is no capsular invasion, conservative management with implant and capsular removal is favored.…”

Breast implant-associated anaplastic large-cell lymphoma and the role of brentuximab vedotin (SGN-35) therapy: A case report and review of the literature

“…The incidence of this disease also remains unclear. Miranda et al suggested this is largely attributed to a lack of standardization regarding pathological examination of mammary implants, with the majority of the institutions recommending gross examination alone (5).…”

Ten-year results from the natrelle® 410 anatomical form stable silicone breast implant core study

“…34 Although the etiology of this condition is not yet known, it is distinct from systemic ALCL and typically characterized by early detection, an indolent course, and high rates of complete remission after treatment via implant removal and capsulectomy. 35 Cases of BIA-ALCL have been reported across implant types (smooth, textured, saline, silicone), across manufacturers, and in subjects with and without prior implant history; however, more cases have been reported with texturedsurface devices. In the present study, 1 subject in her 10th year of follow-up presented with BIA-ALCL that was detected in seroma fluid.…”