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. 2014 Jan 10;32(2):114-20.
doi: 10.1200/JCO.2013.52.7911. Epub 2013 Dec 9.

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

Roberto N Miranda  1 , 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 Jr, Ephram P Hochberg, Matthew J Carty, Summer E Hanson, Eid Mustafa, Steven Sanchez, John T Manning Jr, 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
Affiliations

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

Roberto N Miranda et al. J Clin Oncol. .

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.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Breast implant–associated anaplastic large-cell lymphoma. (A) Overall survival (OS) for all patients. (B) Progression-free survival (PFS) for 60 patients with long-term follow-up. (C) Comparison of OS between patients with and without grossly detected tumor mass. (D) Comparison of PFS between patients with and without grossly detected tumor mass. (E) Comparison of OS between patients who received and who did not receive chemotherapy. (F) Comparison of PFS between patients who received and who did not receive chemotherapy.
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References

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    1. Miranda RN, Lin L, Talwalkar SS, et al. Anaplastic large cell lymphoma involving the breast: A clinicopathologic study of 6 cases and review of the literature. Arch Pathol Lab Med. 2009;133:1383–1390. - PubMed
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    1. US Food and Drug Administration. Anaplastic large cell lymphoma (ALCL) in women with breast implants: Preliminary FDA findings and analyses. 2013. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProst....
    1. US Food and Drug Administration. FDA medical device communication: Reports of anaplastic large cell lymphoma (ALCL) in women with breast implants. 2013. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProst....

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