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Weng H, Shrestha PR, Hong H, Chen Z, Yu L, Yao Y, Zhang Z, Zou L, Zhu B, Zhou H, Liu X, Liu Y, Guo H, Huang H, Lin T. Primary breast diffuse large B-cell lymphoma in the rituximab era: A retrospective study of the Chinese Southwest Oncology Group. Cancer Med 2023; 12:21188-21198. [PMID: 37997571 PMCID: PMC10726850 DOI: 10.1002/cam4.6686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/07/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare subtype of extranodal DLBCL, and the standard treatment remains controversial. In this study, we aimed to define the optimal treatment management in the rituximab era. METHODS A total of 5089 newly diagnosed DLBCL patients treated with rituximab-containing immunochemotherapy between 2008 and 2019 from the Chinese Southwest Oncology Group-affiliated institutes were identified, of whom 135 diagnosed with PB-DLBCL were eligible for this analysis. RESULTS PB-DLBCL accounted for 2.7% of all DLBCLs. With a median follow-up of 4.2 years, the 5-year overall survival and progression-free survival rates were 84.8% and 71.6%, respectively. Breast and central nervous system (CNS) relapses were the main cause of treatment failure. We observed that consolidative breast radiotherapy (RT) significantly decreased breast relapse risk (5-year risk, 2.9% vs. 20.1%, p = 0.007). The CNS relapse risk was lower for patients who received high-dose methotrexate (HD-MTX) than for patients who did not (5-year risk, 0% vs. 15.2%, p = 0.015). We further screened the genetic mutation profile of 20 patients from two institutes, and found that MYD88 (25%) and CD79B mutations (25%) frequently occur in PB-DLBCL. In addition, four patients with MYD88 and/or CD79B mutations experienced CNS relapse, while three patients with MYD88 and/or CD79B mutations who received HD-MTX did not experience CNS relapse. CONCLUSION Collectively, our results indicate combined modality therapy including rituximab-containing immunochemotherapy and consolidative breast RT is a promising approach for PB-DLBCL, while HD-MTX is useful for preventing CNS relapse.
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Affiliation(s)
- Huawei Weng
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Prem Raj Shrestha
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Huangming Hong
- Department of Medical OncologySichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Zegeng Chen
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Le Yu
- Department of Medical OncologySichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Yuyi Yao
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Zhihui Zhang
- Department of Medical OncologySichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Liqun Zou
- Division of Medical Oncology, Cancer Center and State Key Laboratory of BiotherapySichuan University, West China HospitalChengduChina
| | - Bo Zhu
- Institute of Cancer, Xinqiao HospitalArmy Medical UniversityChongqingChina
| | - Hui Zhou
- Tumour Hospital of Xiangya School of MedicineCentral South UniversityChangshaHunanChina
| | - Xianling Liu
- Department of Oncology, Secondary Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Yao Liu
- Chongqing University Cancer HospitalChongqingChina
| | - Hongqiang Guo
- The Affiliated Cancer Hospital of Zhengzhou UniversityHenan Cancer HospitalZhengzhouChina
| | - He Huang
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouChina
| | - Tongyu Lin
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouChina
- Department of Medical OncologySichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
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2
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Cunningham I, Sánchez Sosa S, Hamele-Bena D. Single organ microenvironment and the common features of tumors of leukemia, lymphoma, and myeloma cells growing there: A literature review. Eur J Haematol 2021; 108:169-177. [PMID: 34779527 DOI: 10.1111/ejh.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore whether the growth and treatment resistance of lymphoma and myeloma tumors is similar to that previously observed in leukemic and solid tumors growing in the same organ microenvironment. METHODS All published cases of 3 primary hematologic malignancies in breast, without systemic involvement, were identified, with follow-ups solicited from authors. Treatment approaches were analyzed to highlight the most effective. RESULTS Similar histologic features and biology among primary tumors of leukemia, lymphoma, plasmacytoma, and solid breast cancer was revealed. Review of treatments: tumor-directed, chemotherapy, or combination showed the benefit of tumor removal, and use of systemic agents in adjunct, not primary, treatment. Optimal assessment is limited by few cases of PET/CT verifying limited tumor extent. The common biology observed and cases of long survival after tumor/stroma eradication point to the complicity of organ microenvironment in the chemoresistance and treatment failure commonly observed in patients. CONCLUSIONS The interaction of an organ microenvironment, particularly its adipocytes, with malignant cells, results in similar histologic changes, metastatic potential, and chemoresistance in 3 hematologic malignancies and solid cancers. Improved survival in hematologic malignancies could result from adopting PET/CT to find tumor and its extent, eradicating tumor, and elucidating common therapeutic targets.
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Affiliation(s)
- Isabel Cunningham
- Division of Hematology Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | | | - Diane Hamele-Bena
- Department of Pathology & Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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3
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Morgan S, Tremblay-LeMay R, Lipa JE, Sur M, Delabie J, Imrie K, Crump M, Snell LJ, Ghorab Z. Breast implant-associated EBV-positive diffuse large B-cell lymphoma: Two case reports and literature review. Pathol Res Pract 2021; 226:153589. [PMID: 34455365 DOI: 10.1016/j.prp.2021.153589] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
Lymphomas associated with breast implants are mostly of the T-cell type. They are predominantly anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALK-negative ALCL) characterized by CD30 positivity universally. Whilst the majority of primary breast lymphomas occurring in the absence of breast implants are of B-cell origin, there are few cases of implant-associated B-cell lymphomas reported to date in the literature, a subset of which are diffuse large B-cell lymphoma (DLBCL). Given the rarity of this entity, we describe two cases of breast implant-associated DLBCL. Both patients developed Epstein-Barr Virus (EBV)-positive large cell lymphoma of B-cell origin confined to the implant capsule with no evidence of systemic lymphoma. Considering the association with EBV, the activated B-cell phenotype and the presumed chronic inflammatory environment associated with the implant capsule, these might represent forms of DLBCL associated with chronic inflammation (DLBCL-CI) or fibrin-associated DLBCL (FA-DLBCL). Treatment included implant removal with total capsulectomy, and for one of the cases adjuvant systemic chemotherapy. Recognizing this rare type of breast implant-associated B-cell lymphoma could improve our understanding of this entity and hence develop appropriate management strategies.
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Affiliation(s)
- Sarah Morgan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Rosemarie Tremblay-LeMay
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Ontario, Canada
| | - Joan E Lipa
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Monalisa Sur
- Department of Pathology and Molecular Medicine and Hamilton Regional Laboratory Medicine Program, Juravinski Cancer Centre and Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Jan Delabie
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Pathology and Laboratory Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kevin Imrie
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Crump
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Laura J Snell
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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4
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Zhang XY, Collins GP, Cutter DJ, Eyre TA. Limited-stage diffuse large B-cell lymphoma: current management and challenges. Br J Haematol 2021; 194:508-517. [PMID: 33618434 DOI: 10.1111/bjh.17359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
Twenty-five to thirty per cent of diffuse large B-cell lymphoma (DLBCL) presents as limited stage (I-II). Prognosis is generally excellent with four to six cycles of R-CHOP alone (rituximab, cyclophosphamide, vincristine, doxorubicin, prednisolone) or combined-modality therapy with three or four cycles and involved-site radiotherapy (RT). There is growing interest in optimising algorithms to retain disease control whilst minimising long-term toxicity, with several recent studies focusing on the safety of abbreviating chemotherapy and omitting RT in low-risk patients and the utility of PET-based response-adapted approaches. As these studies are limited to younger patients without risk factors, application of similar approaches in elderly or higher-risk patients is hampered by a lack of evidence. Whilst there has been a move away from using RT in low-risk patients, it remains a useful adjunct in specific situations. Current evidence cannot exclude a clinically meaningful benefit from RT even in low-risk patients and, given the low expected toxicity from modern RT techniques, a risk-benefit assessment should be individualised and considered in a multidisciplinary fashion. The optimal approach for extranodal limited-stage DLBCL (~40% of cases) varies according to site of origin. Herein we discuss the latest clinical trial evidence and how this can be applied in routine practice.
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Affiliation(s)
- Xiao-Yin Zhang
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Graham P Collins
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David J Cutter
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Toby A Eyre
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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5
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Liu H, Zhang J, Quan L, Cao L, Miao Y, Zhao X, Shen H, Wang L, Xu W, Li J, Fan L. Conventional Treatments Cannot Improve Outcomes of Early-Stage Primary Breast Marginal Zone Lymphoma. Front Oncol 2021; 10:609512. [PMID: 33928019 PMCID: PMC8076799 DOI: 10.3389/fonc.2020.609512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Primary breast marginal zone lymphoma (PBMZL) is a rare occurrence and less is known about its characteristics, treatments, and outcomes. Methods We retrospectively reviewed 370 cases of early-stage PBMZL from the Surveillance, Epidemiology, and End Results database. Statistical analyses were performed to describe clinical features, determine prognostic factors, and compare different therapeutic strategies. Results At a median follow-up of 68.5 months, the 5-year overall survival (OS) and disease-specific survival (DSS) rate were 81.2 and 95.4%, respectively. We divided the cohort into four treatment groups and compared their characteristics and survival: radiotherapy (RT) ± surgery (Sx) (n = 142, 38.4%), Sx alone (n = 71, 19.2%), any chemotherapy (CT) (n = 63, 17.0%), and none of the above (n = 94, 25.4%). Age of onset and laterality of lesions tended to relate to the choice of different treatments. Multivariate Cox analysis showed that advanced age (>60 years), concomitant tumor, and any CT (vs RT ± Sx) predicted poorer OS, while for DSS, there was no meaningful indicator (P > 0.05). Patients aged >60 years or treated with any CT seemed to have shorter DSS, but the difference only approached statistical significance. Then we applied a propensity score-matched analysis to demonstrate that neither RT- nor Sx-containing therapy could bring a better OS or DSS. The competing risk model suggested that CT was the only contributor to higher PBMZL-specific mortality. Conclusion Our results show an indolent behavior of early-stage PBMZL with long-term survival. Conventional oncological treatments fail to bring survival benefits; especially CT is detrimental to survival, suggesting that observation may be advisable in the management of early-stage PBMZL, and further research on novel targeted agents is warranted for patients in need.
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Affiliation(s)
- Hailing Liu
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Jing Zhang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Lin Quan
- Department of Respiratory, Nanjing Chest Hospital, Chest Hospital District, Nanjing Brain hospital affiliated to Nanjing Medical University, Nanjing, China
| | - Lei Cao
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Yi Miao
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Xiaoli Zhao
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Haorui Shen
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Li Wang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Wei Xu
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Jianyong Li
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
| | - Lei Fan
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China
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6
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Kobayashi H, Asada N, Igawa T, Abe M, Meguri Y, Ennishi D, Nishimori H, Fujii N, Matsuoka KI, Yoshino T, Maeda Y. Adult T-cell Leukemia-lymphoma with Primary Breast Involvement: A Case Report and Literature Review. Intern Med 2020; 59:2757-2761. [PMID: 32641657 PMCID: PMC7691018 DOI: 10.2169/internalmedicine.5077-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Breast involvement of Adult T-cell leukemia-lymphoma (ATLL) is extremely rare, and the data on the characteristics are limited. We herein describe a 49-year-old woman who presented with skin involvement of ATLL. Positron emission tomography/computed tomography showed bilateral breast lesions. Although the patient once achieved a complete metabolic response, a relapse of her ATLL occurred. The patient received subsequent allogeneic hematopoietic stem cell transplantation (HSCT). To our knowledge, only four cases of ATLL with breast involvement have previously been reported, and the prognoses have generally been poor. Breast lesions of ATLL have aggressive features, and intensive systemic chemotherapy and HSCT are required to improve survival.
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Affiliation(s)
- Hiroki Kobayashi
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Noboru Asada
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Takuro Igawa
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Masaya Abe
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Yusuke Meguri
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Nobuharu Fujii
- Department of Transfusion Medicine, Okayama University Hospital, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Yoshinobu Maeda
- Department of Hematology and Oncology, Okayama University Hospital, Japan
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7
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Foo MY, Lee WP, Seah CMJ, Kam C, Tan S. Primary breast lymphoma: A single-centre experience. Cancer Rep (Hoboken) 2019; 2:e1140. [PMID: 32721093 PMCID: PMC7941582 DOI: 10.1002/cnr2.1140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Primary non-Hodgkin lymphoma is an extremely rare entity, and this condition represents less than 0.5% of all malignant lesions involving the mammary gland. As such, there has been a paucity of relevant clinical data arising from Southeast Asia. AIMS Our study aims to review the clinical presentation, diagnostic methods, treatment, and survival outcomes of all patients diagnosed with primary breast lymphoma in our institution between 2011 and 2017. METHODS AND RESULTS Patients who had histologically proven lymphoma involving the breast were identified from a prospectively collected database in a single institution between 2011 and 2017. All seven patients were female, with a median age of 65 years old, and had presented with unilateral large breast or axillary masses. All the histological diagnosis was achieved with adequate tissue diagnosis either through core, incisional, or excisional biopsy. Five patients had diffuse large B cell lymphoma, one had marginal zone lymphoma, and the other had follicular lymphoma. Based on Ann Arbor classification, one patient had stage 1, three had stage 2, one with stage 3, and two patients with stage 4 disease. Five patients had received standard CHOP regimen with rituximab. At the time of analysis, patients who had nondisseminated disease had a median survival of 57 months. The overall mean survival time for all seven patients was 47 months. With the standard systemic chemotherapy treatment regimen, the estimated 3-year overall survival was found to be 64%. CONCLUSION Primary breast lymphoma, though uncommon, may present in a similar manner as breast carcinomas, but the main treatment modality remains nonsurgical with systemic chemotherapy. Hence, it is prudent to obtain accurate histological diagnosis of primary breast lymphoma. In this study, our patients with nondisseminated breast lymphoma have demonstrated a fairly good survival outcome following chemotherapy.
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Affiliation(s)
- Mang Yik Foo
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
| | - Wai Peng Lee
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
| | - Chin Mui Jaime Seah
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
| | - Carmen Kam
- Clinical Trials and Research UnitChangi General HospitalSingapore
| | - Su‐Ming Tan
- Division of Breast Surgery, Department of General SurgeryChangi General HospitalSingapore
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8
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Liu P, Wang K, Jin J, Bi X, Sun P, Wang Y, Yang H, Li Z, Jiang W, Xia Y. Role of radiation therapy in primary breast diffuse large B-cell lymphoma in the Rituximab era: a SEER database analysis. Cancer Med 2018; 7:1845-1851. [PMID: 29624913 PMCID: PMC5943465 DOI: 10.1002/cam4.1457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/23/2018] [Accepted: 02/28/2018] [Indexed: 11/08/2022] Open
Abstract
Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is an uncommon extranodal non-Hodgkin's lymphoma (NHL), which was traditionally treated with anthracycline-containing regimens followed by consolidative radiation therapy (RT) to add therapeutic benefits. The introduction of anti-CD20 antibody rituximab for the treatment of B-cell NHLs has significantly improved the clinical outcome of these malignant diseases. It is unclear, however, whether consolidative RT could still add therapeutic benefits for PB-DLBCL patients treated with rituximab. To answer this important question, we used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the impact of RT on the clinical outcomes of PB-DLBCL patients in the rituximab era. Information on patient age, year of diagnosis, stage, race, laterality, and RT status for PB-DLBCL patients diagnosed between 2001 and 2014 were extracted. Kaplan-Meier survival curves were plotted, and log-rank test was used to compare the potential survival difference. Multivariate analysis using Cox proportional hazards model was employed to determine the impact of RT and other factors such as age, race, tumor laterality, stage, and year of diagnosis on survival. Among the 386 patients identified, the median follow-up time was 45 months (range, 0-167 months); the median age was 64 years (range, 19-93 years); 33.9% of the patients were younger than 60 years of age; 69.9% of the patients were stage I; 79.0% were white; 51.8% received RT. The 5-year OS and cause-specific survival (CSS) for the whole cohort were 72.3% and 82.5%, respectively. The 5-year OS was significantly superior for patients who received RT compared to those who did not receive RT (78.1% vs. 66.0%, P = 0.031). In multivariable analysis, RT remained significantly associated with improved OS (P = 0.026). In summary, our study suggests that RT still adds significant therapeutic benefits for patients with PB-DLCBL in the rituximab era.
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Affiliation(s)
- Pan‐pan Liu
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Ke‐feng Wang
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Jie‐tian Jin
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
- Department of Thoracic SurgeryThe Sun Yat‐sen Memorial Hospital of Sun Yat‐sen UniversityGuangzhou510120China
| | - Xi‐wen Bi
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Peng Sun
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Yu Wang
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Hang Yang
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Zhi‐ming Li
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Wen‐qi Jiang
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
| | - Yi Xia
- Department of Medical OncologySun Yat‐sen University Cancer Center651 Dong Feng East RoadGuangzhouGuangdong510060China
- State Key Laboratory of Oncology in South ChinaGuangzhouGuangdong510060China
- Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong510060China
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9
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Jia Y, Sun C, Liu Z, Wang W, Zhou X. Primary breast diffuse large B-cell lymphoma: a population-based study from 1975 to 2014. Oncotarget 2018; 9:3956-3967. [PMID: 29423097 PMCID: PMC5790514 DOI: 10.18632/oncotarget.23285] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022] Open
Abstract
Primary breast diffuse large B-cell lymphoma (DLBCL) is a rare non-Hodgkin's lymphoma with limited data. In this study, a population-based study of primary breast DLBCL in the United States was performed to determine its incidence trends, prognostic factors, survival, the role of surgery as well as the comparison with nodal DLBCL. 1021 patients diagnosed with breast DLBCL were identified in the Surveillance, Epidemiology, and End Results (SEER) cancer registries from 1973-2014. The incidence of both breast and nodal DLBCL increased over time. Patients with breast DLBCL were older, mainly women, diagnosed at earlier stages and had lower prevalence in white and black races compared with nodal DLBCL. Multivariate analysis revealed older age (≥ 70 years old) and advanced stage as independent predictors of worse OS. Independent predictor of better DSS were younger age (< 70 years old), early stage and diagnosis after 2000. When analyzed according to age, stage, race, tumor laterality and year of diagnosis, the overall survival did not benefit from surgery except in patients diagnosed between 2001-2010 and the surgery rate decreased overtime. Compared with nodal DLBCL, breast DLBCL patients exhibited a better outcome. In conclusion, breast DLBCL is a rare tumor with increasing incidence and improved survival over the last four decades. The introduction of rituximab seems to improve the outcome of breast DLBCL. Further studies are needed to advance our understanding of breast DLBCL and optimize the treatment strategy.
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Affiliation(s)
- Yijun Jia
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Pathology, Fudan University, Shanghai 200032, China
| | - Chenbo Sun
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Pathology, Fudan University, Shanghai 200032, China
| | - Zebing Liu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Pathology, Fudan University, Shanghai 200032, China.,Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
| | - Weige Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Pathology, Fudan University, Shanghai 200032, China
| | - Xiaoyan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Institute of Pathology, Fudan University, Shanghai 200032, China
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Al Battah AH, Al Kuwari EA, Hascsi Z, Nashwan AJ, Elomari H, Elsabah H, Al Azawi S, Kohla S, Soliman D, Yassin MA. Diffuse Large B-Cell Breast Lymphoma: A Case Series. Clin Med Insights Blood Disord 2017; 10:1179545X17725034. [PMID: 28839450 PMCID: PMC5560510 DOI: 10.1177/1179545x17725034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/11/2017] [Indexed: 01/24/2023]
Abstract
Primary breast lymphoma (PBL) is a rare disease, and few clinicohistopathologic features of the disease have been discussed in previous studies. It represents 2.2% of extranodal lymphomas and constitutes 0.04% to 0.5% of malignant breast neoplasms, despite the clinical and radiographic similarities between breast lymphoma and carcinoma, the prognosis, as reported in the literature, varies. No consensus exists on the best way to treat PBL. However, radiotherapy and chemotherapy were used alone or in combination to treat various cases of PBL. We retrospectively studied 3 cases of PBL of the breast seen in patients attending a tertiary cancer center in Qatar, between 2012 and 2015, in an attempt to determine the common clinical features, therapy, and prognosis of PBL.
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Affiliation(s)
- Afaf H Al Battah
- Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | | | - Zsolt Hascsi
- Radiology Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdulqadir J Nashwan
- Nursing Department, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Halima Elomari
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hisham Elsabah
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Safa Al Azawi
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Samah Kohla
- Department of Laboratory Medicine and Pathology, National Centre for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Dina Soliman
- Department of Laboratory Medicine and Pathology, National Centre for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar.,National Cancer Institute, Cairo, Egypt
| | - Mohamed A Yassin
- Division of Hematology, Department of Medical Oncology, National Center for Cancer Care & Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
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11
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Thomas A, Link BK, Altekruse S, Romitti PA, Schroeder MC. Primary Breast Lymphoma in the United States: 1975-2013. J Natl Cancer Inst 2017; 109:3071263. [PMID: 28376147 DOI: 10.1093/jnci/djw294] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/31/2016] [Indexed: 11/14/2022] Open
Abstract
Background Primary breast lymphoma (PBL) has gained attention with the description of breast implant-associated anaplastic large cell lymphoma (ALCL). Less is known about PBL incidence, treatment, and survival by lymphoma subtype. Methods The Surveillance, Epidemiology, and End Results (SEER) registry database was queried for patients with PBL as first malignancy, with attention to non-Hodgkin Lymphoma PBL subtypes: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, marginal zone lymphoma (MZL), and ALCL. Incidence was estimated by age and subtype with joinpoint analyses, along with initial local therapy. Five-year relative and overall survival estimates were compared using z and two-sided log-rank tests. Results PBL incidence (per 1 000 000 women) increased from 0.66 (1975-1977) to 2.96 (2011-2013) with an annual percentage change (APC) of 5.3% (95% confidence interval [CI] = 3.8% to 6.9%, P < .001) from 1975 to 1999 and no statistically significant change thereafter. Incidence continues to increase for women younger than age 50 years (APC = 2.8%, 95% CI = 1.0% to 4.6%, P = .003) and for ALCL-PBL (APC = 11.8%, 95% CI = 0.2% to 24.9%, P = .047) and MZL-PBL (APC = 2.3%, 95% CI = -0.2% to 4.9%, P = .07), with the latter increasing significantly from 1995 to 2013 (APC = 7.5%, 95% CI = 3.4% to 11.8%, P = .001). Surgery and surgery with radiation declined from 2000 to 2013 as initial local therapy for PBL. Five-year relative survival for PBL improved markedly over four decades and was superior for stage I DLBCL-PBL and stage I follicular PBL than for corresponding systemic presentations. Conclusions PBL has increased in incidence over the last four decades and continues to increase for younger women and for some subtypes. The rise in imaging and procedures to the breast might enhance diagnostic sensitivity for PBL. Further study of the etiologies of PBL is needed.
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Affiliation(s)
- Alexandra Thomas
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Brian K Link
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Sean Altekruse
- Division of Health Services Research, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA.,Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, Interdisciplinary Program in Toxicology, University of Iowa, Iowa City, IA, USA.,Department of Biostatistics, College of Public Health, Interdisciplinary Program in Toxicology, University of Iowa, Iowa City, IA, USA
| | - Mary C Schroeder
- Division of Health Services Research, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
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12
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How I treat patients with aggressive lymphoma at high risk of CNS relapse. Blood 2017; 130:867-874. [PMID: 28611025 DOI: 10.1182/blood-2017-03-737460] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/11/2017] [Indexed: 12/25/2022] Open
Abstract
Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis.
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13
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Franco Pérez F, Lavernia J, Aguiar-Bujanda D, Miramón J, Gumá J, Álvarez R, Gómez-Codina J, Arroyo FG, Llanos M, Marin M, Alfaro J, Quero C, Delgado M, Nogales E, Menarguez F, Martinez N, Torrente M, Royuela A, Abreu D, Provencio M. Primary Breast Lymphoma: Analysis of 55 Cases of the Spanish Lymphoma Oncology Group. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 17:186-191. [PMID: 27847267 DOI: 10.1016/j.clml.2016.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/03/2016] [Accepted: 09/08/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary breast lymphoma is a rare form of localized extranodal lymphoma, which affects the mammary glands unilaterally or bilaterally, and can also affect the regional lymph nodes. MATERIALS AND METHODS We reviewed 55 patients, with disease stages IE and IIE, diagnosed in 16 Spanish institutions between 1989 and 2016. A serial of clinical variables and treatment were collected, and overall survival (OS) and progression-free survival (PFS) were calculated. RESULTS Of the 55 patients, 96.4% were women with an average age of 69 years. A total of 53 patients corresponded to non-Hodgkin lymphoma (NHL), of whom 36.3% had lymph node involvement upon diagnosis. Of the patients, 58.2% were stage IE, and 41.8% were stage IIE. Treatments received included radiotherapy (36.3%), chemotherapy (85.5%), and rituximab (in 38 of the 45 patients with NHL treated with chemotherapy). In all, 82.2% of complete responses were achieved. OS and progression-free survival at 5 years in NHL patients was 76% and 73%, respectively. CONCLUSION Current treatments (chemotherapy, immunotherapy, and radiotherapy) achieve good control of the disease, with an OS of 5 years in 80% of the patients, although there is no consensus in treatment, given the scarce incidence of these lymphomas.
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Affiliation(s)
- Fernando Franco Pérez
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
| | - Javier Lavernia
- Department of Medical Oncology, Instituto Valenciano de Oncología, Valencia, Spain
| | - David Aguiar-Bujanda
- Department of Medical Oncology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canarias, Spain
| | - José Miramón
- Department of Medical Oncology, Hospital Serranía de Ronda, Málaga, Spain
| | - Josep Gumá
- Department of Medical Oncology, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Rut Álvarez
- Department of Medical Oncology, Hospital Universitario Virgen de la Salud, Toledo, Spain
| | - José Gómez-Codina
- Department of Medical Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Marta Llanos
- Department of Medical Oncology, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Spain
| | - Miguel Marin
- Department of Medical Oncology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Jesus Alfaro
- Department of Medical Oncology, Instituto Oncológico de Kutxa, Donistia, Spain
| | - Cristina Quero
- Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Mayte Delgado
- Department of Medical Oncology, Hospital Universitario San Cecilio, Granada, Spain
| | - Esteban Nogales
- Department of Medical Oncology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Francisco Menarguez
- Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain
| | - Natividad Martinez
- Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain
| | - Maria Torrente
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ana Royuela
- Department of Biostatistics, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Delvys Abreu
- Department of Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canarias, Spain
| | - Mariano Provencio
- Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Ishibashi N, Hata M, Mochizuki T, Ogawa K, Sugiura H, Takekawa Y, Maebayashi T, Aizawa T, Sakaguchi M, Abe O. Radiation therapy for primary breast lymphoma in male gynecomastia: a rare case report and review of the literature. Int J Hematol 2016; 104:519-24. [DOI: 10.1007/s12185-016-2026-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 01/18/2023]
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15
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Huang Y, Xu W, Li J. [Research advances in primary breast lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 36:1056-8. [PMID: 26759113 PMCID: PMC7342326 DOI: 10.3760/cma.j.issn.0253-2727.2015.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ying Huang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
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16
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17
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Jakó J, Szerafin L. [Extranodal lymphomas in adults in Szabolcs-Szatmár-Bereg county, Hungary. Analysis of 30 years' epidemiologic data]. Orv Hetil 2015; 156:98-104. [PMID: 25577681 DOI: 10.1556/oh.2015.30047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In their previous work, the authors reported 27-year' findings on the epidemiology of extranodal lymphomas in Szabolcs-Szatmár-Bereg county, Hungary. There are no other studies on this topic available in Hungary. AIM The aim of this study was to analyse in detail the epidemiologic data of patients with non-Hodgkin's lymphoma who were recorded in the leukaemia/lymphoma registry of Szabolcs-Szatmár-Bereg county during a 30-year period, to compare the main epidemiologic features of the extranodal and nodal forms, and compare the results with data reported in the international literature. METHOD Between January 1, 1983 and December 31, 2012, 1123 adult patients with newly diagnosed non-Hodgkin's lymphoma were recorded in the leukaemia/lymphoma registry of Szabolcs-Szatmár-Bereg county. Of those, 347 patients suffered from extranodal, and 776 patients from nodal form of non-Hodgkin's lymphoma. The authors compared the incidence of the extranodal and nodal forms, the age and sex distribution of patients, the ratio of B- and T-cell, as well as the indolent and aggressive forms, the geographic distribution and the association with carcinomas. In addition, they studied the occurrence of familial appearance and the localisation of extranodal forms. RESULTS The occurrence of non-Hodgkin's lymphomas indicated an increasing tendency in their county. This tendency was true for both the extranodal and nodal forms, but it was more remarkable in the extranodal form of lymphomas. They found no substantial difference between the main epidemiologic features of the two forms. The gastrointestinal tract was the most frequent site of presentation for extranodal lymphomas. CONCLUSIONS These observations are in line with data reported in the international literature. The data are essentially similar to those published in populations from Western European countries and the United States.
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Affiliation(s)
- János Jakó
- Szabolcs-Szatmár-Bereg Megyei Jósa András Oktatókórház Hematológiai Osztály Nyíregyháza
| | - László Szerafin
- Szabolcs-Szatmár-Bereg Megyei Jósa András Oktatókórház Hematológiai Osztály Nyíregyháza
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18
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Shao YB, Sun XF, He YN, Liu CJ, Liu H. Clinicopathological features of thirty patients with primary breast lymphoma and review of the literature. Med Oncol 2015; 32:448. [PMID: 25572809 DOI: 10.1007/s12032-014-0448-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
Primary breast lymphoma (PBL) is a rare disease accounting for 0.4-0.5 % of all breast malignancies. Accumulating evidence indicates that the diagnosis, prognostic factors, and optimal management of PBL are difficult. The present study aims to investigate the clinicopathological features and optimal treatment of PBL and to evaluate the institutional experience in this patient population. A total of 30 patients with PBL from January 2002 to December 2012 treated in He'nan Province Tumor Hospital were selected. The patients' clinical and pathological characteristics, treatment and response data, patterns of recurrence, and outcomes were retrospectively analyzed, and the relevant literatures were reviewed. All the cases were female, and the median age was 45. Diffuse large B cell lymphoma was the most common histological subtype seen in 23 of 30 patients. With a median follow-up time 32 months, median OS was 42 months (95 % CI 25-58 months), with 5-year OS rates 48 % (95 % CI 36-59 %). The median PFS was 14 months (95 % CI 6-30 months), with 5-year PFS rates 32 % (95 % CI 20-45 %). The prognostic factors that retained statistical significance for OS were IPI (P < 0.001), age (P = 0.04), and stage (P < 0.001). For PFS, significant prognostic factors were IPI (P = 0.01), radiotherapy given (P = 0.02) and stage (P = 0.02). PBL appears to have a worse prognosis. The present treatment method for PBL is a comprehensive way of diagnostic surgery together with radiotherapy and chemotherapy.
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Affiliation(s)
- Y B Shao
- Department of Breast Oncology, The Affiliated Cancer Hospital of Zhengzhou University, 127 Dongming Road, Zhengzhou, 450008, China
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19
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Primary breast lymphoma. Cancer Treat Rev 2014; 40:900-8. [PMID: 24953564 DOI: 10.1016/j.ctrv.2014.05.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 01/01/2023]
Abstract
Primary breast lymphoma is a rare form of extranodal lymphoma, defined by the presence of a primary lesion within the breast with or without regional nodal involvement but no other extra-mammary sites of involvement. It comprises diverse histologic subtypes, but diffuse large B-cell lymphoma is the most common. In this review, we describe in detail the clinical features, diagnosis and staging, pathogenesis, risk factors and therapy of primary breast diffuse large B-cell lymphoma. We consider choice and number of cycles of chemotherapy, the indications for radiotherapy and discuss the need for central nervous system prophylaxis. We also provide a brief overview of the less commonly encountered histologic subtypes including marginal zone, follicular, Burkitt and breast implant associated anaplastic large cell lymphoma. We conclude with a suggested treatment approach and potential areas of future research.
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20
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Cheah CY, Seymour JF, Dickinson M. Ongoing challenge of optimal patient selection for CNS prophylaxis in patients with non-Hodgkin lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SUMMARY CNS relapse is a devastating and frequently lethal complication in patients with lymphoma, and selecting patients to receive CNS-directed prophylaxis is a common and frequently challenging decision for the clinician. Histologic subtype, anatomic location, molecular and clinical risk factors may all be used to stratify patients for CNS risk. In this paper we focus on these issues and attempt to provide practical guidance for the clinician in selecting which patients with lymphoma may benefit from CNS prophylaxis.
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Affiliation(s)
- Chan Yoon Cheah
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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21
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Aviv A, Tadmor T, Polliack A. Primary diffuse large B-cell lymphoma of the breast: looking at pathogenesis, clinical issues and therapeutic options. Ann Oncol 2013; 24:2236-44. [PMID: 23712546 DOI: 10.1093/annonc/mdt192] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary breast lymphoma is a rare form of non-Hodgkin lymphoma with some distinct clinical features. The most common histopathological type is diffuse large B-cell lymphoma (DLBCL), but other less frequent subtypes are also encountered. In this review, we describe the characteristics of primary breast DLBCL, with emphasis on pathogenesis, staging, risk stratification and prognosis. In addition, key issues regarding therapy and various available therapeutic modalities are addressed, as well as the role of rituximab in therapy and whether central nervous system prophylaxis is still routinely required. There are very few prospective clinical studies addressing therapy, and available data rely mostly on retrospective case series involving small numbers of patients. Our conclusions and proposed recommendations are therefore not offered as formal guidelines. This review attempts to represent an unbiased analysis of the published data and is intended as a useful aid for clinicians treating this uncommon type of extra nodal lymphoma.
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Affiliation(s)
- A Aviv
- Hematology Unit, Emek Medical Center, Afula, Israel
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22
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Tang TC, Chang H, Chuang WY. Primary breast lymphoma sequentially relapsed in the peripheral and central nervous system. Acta Neurol Belg 2012; 112:271-4. [PMID: 22426680 DOI: 10.1007/s13760-012-0052-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/06/2012] [Indexed: 10/28/2022]
Abstract
Primary breast lymphoma (PBL) is an uncommon extranodal type of lymphoma, exhibiting more aggressive behavior and poorer prognosis. Patients with PBL have a higher incidence to relapse in central nervous system (CNS), which is always leading to a dismal outcome even treating with high intensity chemotherapy plus radiotherapy. Lymphoma involving the peripheral nervous system (PNS), either primarily or secondarily, is also rare. But no PBL with PNS relapse has been reported before. Herein, we reported a case of PBL who presented with subsequent relapse in two discrete sites of the PNS followed by the CNS.
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Lazzeri D, Agostini T, Bocci G, Giannotti G, Fanelli G, Naccarato AG, Danesi R, Tuccori M, Pantaloni M, D'Aniello C. ALK-1-negative anaplastic large cell lymphoma associated with breast implants: a new clinical entity. Clin Breast Cancer 2011; 11:283-96. [PMID: 21729665 DOI: 10.1016/j.clbc.2011.03.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/21/2011] [Accepted: 03/01/2011] [Indexed: 11/17/2022]
Abstract
Concerns have been raised recently regarding the increasing number of reports of non-Hodgkin lymphoma (NHL) that developed in close proximity to silicone or saline breast implants. In particular, an increased risk of anaplastic large cell lymphoma (ALCL) in patients with breast prostheses has been proposed. We reviewed clinical and pathologic findings in 40 women who received a diagnosis of breast NHL arising in association with breast implants and of 27 patients who had a diagnosis of ALCL with breast involvement reported in the published literature. Among the 40 reported cases of prosthesis-associated breast lymphomas, 28 were anaplastic lymphoma kinase-1-negative (ALK-1(-)) ALCLs, whereas of 27 ALCLs in patients without implants found in the literature, only 10 were ALK-1(-). The finding of 28 cases of breast ALK-1(-) ALCL occurring in patients with implants compared with 10 cases in women without implants is in favor of an association between silicone breast prostheses and ALK-1(-) ALCL. Although the incidence of this type of lymphoma remains remarkably low given that breast prostheses have been widely used for decades, clinical and pathologic evidence for a causative role is becoming dramatically strong. The histologic, phenomenologic, and clinical similarities of the majority of implant-related ALK-1(-) ALCLs suggest a common mechanism, especially when compared with the counterpart of patients without implants in which very few and highly dishomogeneous cases of the same malignancy were detected. There is convincing evidence that primary implant-related ALK-1(-) ALCL represents a distinct clinicopathologic entity that has been inappropriately fitted into the category of systemic ALK-1(-) ALCL. Thus it should be recognized as a separate category and classified on its own.
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Affiliation(s)
- Davide Lazzeri
- Plastic and Reconstructive Surgery Unit, Hospital of Pisa, Italy.
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Bilateral primary breast lymphoma masquerading as lactating mastitis. Eur J Obstet Gynecol Reprod Biol 2010; 152:111-2. [PMID: 20728042 DOI: 10.1016/j.ejogrb.2010.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 04/20/2010] [Accepted: 05/24/2010] [Indexed: 11/21/2022]
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Primary and secondary T-cell lymphomas of the breast: clinico-pathologic features of 11 cases. Appl Immunohistochem Mol Morphol 2009; 17:301-6. [PMID: 19318917 DOI: 10.1097/pai.0b013e318195286d] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Breast involvement by non-Hodgkin lymphomas is rare, and exceptional for T-cell lymphomas; we studied the morphologic, immunophenotypic, and clinical features of 11 patients with T-cell non-Hodgkin lymphomas involving the breast. Four cases fulfilled the definition criteria for primary breast lymphomas, 3 females and 1 male, with a median age of 51 years. One primary breast lymphomas was T-cell lymphoma unspecified, other was subcutaneous panniculitis-like T-cell lymphoma, and 2 cases were anaplastic large cell lymphomas. One of the anaplastic large cell lymphoma cases was found surrounding a silicone breast implant and presented as clinically as mastitis; whereas the other case occurred in a man. T-cell lymphoma secondarily involved the breast in 7 patients, all women and 1 bilateral, with a median age of 29 years. These secondary breast lymphomas occurred as part of widespread nodal or leukemic disease. Three patients had adult T-cell leukemia/lymphoma, including the patient with bilateral lesions, 3 others had precursor T-lymphoblastic lymphoma/leukemia, and the other presented with a peripheral-T-cell lymphoma non otherwise specified type. Breast T-cell lymphomas are very infrequent and are morphologically and clinically heterogeneous.
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Affiliation(s)
- Kristin L Cox
- Virginia Clinton Kelley/FFANY Breast Fellowship, Komen Interdisciplinary Breast Fellowship, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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