Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma

Mark W. Clemens, L. Jeffrey Medeiros, Charles E. Butler, Kelly K. Hunt, Michelle A. Fanale, Steven Horwitz, Dennis D. Weisenburger, Jun Liu, Elizabeth A. Morgan, Rashmi Kanagal-Shamanna, Vinita Parkash, Jing Ning, Aliyah R. Sohani, Judith A. Ferry, Neha Mehta-Shah, Ahmed Dogan, Hui Liu, Nora Thormann, Arianna DiNapoli, Stephen LadeJorge Piccolini, Ruben Reyes, Travis Williams, Colleen M. McCarthy, Summer E. Hanson, Loretta J. Nastoupil, Rakesh Gaur, Yasuhiro Oki, Ken H. Young, Roberto N. Miranda

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Purpose. Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. Patients and Methods In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. Results. Themedian and mean follow-up timeswere 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomywith breast implant removal had better OS(P = .022) and EFS(P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. Conclusion. Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.

Original languageEnglish (US)
Pages (from-to)160-168
Number of pages9
JournalJournal of Clinical Oncology
Volume34
Issue number2
DOIs
StatePublished - Jan 10 2016
Externally publishedYes

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Anaplastic Large-Cell Lymphoma
Breast Implants
Disease-Free Survival
Capsules
Survival
Lymphoma
T-Cell Lymphoma
Therapeutics
Disease Management
Radiotherapy
Survival Rate
Drug Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Clemens, M. W., Medeiros, L. J., Butler, C. E., Hunt, K. K., Fanale, M. A., Horwitz, S., ... Miranda, R. N. (2016). Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. Journal of Clinical Oncology, 34(2), 160-168. https://doi.org/10.1200/JCO.2015.63.3412

Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. / Clemens, Mark W.; Medeiros, L. Jeffrey; Butler, Charles E.; Hunt, Kelly K.; Fanale, Michelle A.; Horwitz, Steven; Weisenburger, Dennis D.; Liu, Jun; Morgan, Elizabeth A.; Kanagal-Shamanna, Rashmi; Parkash, Vinita; Ning, Jing; Sohani, Aliyah R.; Ferry, Judith A.; Mehta-Shah, Neha; Dogan, Ahmed; Liu, Hui; Thormann, Nora; DiNapoli, Arianna; Lade, Stephen; Piccolini, Jorge; Reyes, Ruben; Williams, Travis; McCarthy, Colleen M.; Hanson, Summer E.; Nastoupil, Loretta J.; Gaur, Rakesh; Oki, Yasuhiro; Young, Ken H.; Miranda, Roberto N.

In: Journal of Clinical Oncology, Vol. 34, No. 2, 10.01.2016, p. 160-168.

Research output: Contribution to journalArticle

Clemens, MW, Medeiros, LJ, Butler, CE, Hunt, KK, Fanale, MA, Horwitz, S, Weisenburger, DD, Liu, J, Morgan, EA, Kanagal-Shamanna, R, Parkash, V, Ning, J, Sohani, AR, Ferry, JA, Mehta-Shah, N, Dogan, A, Liu, H, Thormann, N, DiNapoli, A, Lade, S, Piccolini, J, Reyes, R, Williams, T, McCarthy, CM, Hanson, SE, Nastoupil, LJ, Gaur, R, Oki, Y, Young, KH & Miranda, RN 2016, 'Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma', Journal of Clinical Oncology, vol. 34, no. 2, pp. 160-168. https://doi.org/10.1200/JCO.2015.63.3412
Clemens, Mark W. ; Medeiros, L. Jeffrey ; Butler, Charles E. ; Hunt, Kelly K. ; Fanale, Michelle A. ; Horwitz, Steven ; Weisenburger, Dennis D. ; Liu, Jun ; Morgan, Elizabeth A. ; Kanagal-Shamanna, Rashmi ; Parkash, Vinita ; Ning, Jing ; Sohani, Aliyah R. ; Ferry, Judith A. ; Mehta-Shah, Neha ; Dogan, Ahmed ; Liu, Hui ; Thormann, Nora ; DiNapoli, Arianna ; Lade, Stephen ; Piccolini, Jorge ; Reyes, Ruben ; Williams, Travis ; McCarthy, Colleen M. ; Hanson, Summer E. ; Nastoupil, Loretta J. ; Gaur, Rakesh ; Oki, Yasuhiro ; Young, Ken H. ; Miranda, Roberto N. / Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 2. pp. 160-168.
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abstract = "Purpose. Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. Patients and Methods In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. Results. Themedian and mean follow-up timeswere 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93{\%} and 89{\%} at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomywith breast implant removal had better OS(P = .022) and EFS(P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. Conclusion. Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.",
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T1 - Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma

AU - Clemens, Mark W.

AU - Medeiros, L. Jeffrey

AU - Butler, Charles E.

AU - Hunt, Kelly K.

AU - Fanale, Michelle A.

AU - Horwitz, Steven

AU - Weisenburger, Dennis D.

AU - Liu, Jun

AU - Morgan, Elizabeth A.

AU - Kanagal-Shamanna, Rashmi

AU - Parkash, Vinita

AU - Ning, Jing

AU - Sohani, Aliyah R.

AU - Ferry, Judith A.

AU - Mehta-Shah, Neha

AU - Dogan, Ahmed

AU - Liu, Hui

AU - Thormann, Nora

AU - DiNapoli, Arianna

AU - Lade, Stephen

AU - Piccolini, Jorge

AU - Reyes, Ruben

AU - Williams, Travis

AU - McCarthy, Colleen M.

AU - Hanson, Summer E.

AU - Nastoupil, Loretta J.

AU - Gaur, Rakesh

AU - Oki, Yasuhiro

AU - Young, Ken H.

AU - Miranda, Roberto N.

PY - 2016/1/10

Y1 - 2016/1/10

N2 - Purpose. Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. Patients and Methods In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. Results. Themedian and mean follow-up timeswere 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomywith breast implant removal had better OS(P = .022) and EFS(P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. Conclusion. Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.

AB - Purpose. Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. Patients and Methods In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. Results. Themedian and mean follow-up timeswere 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomywith breast implant removal had better OS(P = .022) and EFS(P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. Conclusion. Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.

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