Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) can be reliably diagnosed and surgically treated with a good prognosis, according to new research presented at Plastic Surgery The Meeting 2015 in Boston.
“This study suggests that advanced ALCL is not a separate clinical entity, but may be a consequence of a delay in treatment or suboptimal treatment of the disease,” says study author Charles E. Butler, MD, Houston plastic surgeon and President-elect of The Plastic Surgery Foundation. The Plastic Surgery Foundation (The PSF) is the research arm of the American Society of Plastic Surgeons (ASPS).
“Definitive surgery with implant removal and total capsulectomy appears to be the optimal primary treatment for patients with BIA-ALCL. Overall, this is a positive message for the rarity and treatability of the disease,” he adds.
The retrospective review of 27 patients with advanced BIA-ALCL comprised individuals with bilateral disease (n=3), lymph node metastases (n=24), and disease-related death (n=6). Sixty-five patients were included in the control group. A retrospective review of all published cases from 1997 to 2015 and unpublished cases at our institution of BIA-ALCL was performed, and patients with advanced disease were selected and corresponding authors were contacted to update clinical follow up.
Treatment types for the advanced BIA-ALCL patients included definitive surgery, n=16 (59.3%); limited surgery, n=19 (70.4%); chemotherapy, n=24 (88.9%); salvage chemotherapy, n=11 (40.7%); radiation, n=15 (55.6%); and autologous stem cell transplant, n=5 (18.5%). None of the patients who died from BIA-ALCL were treated with definitive surgery.
Outcomes for the aggressive-variant patients were complete remission, n=18 (66.7%); death of ALCL, n=6 (22.2%); death of unrelated disease, n=2 (7.4%); and alive with ALCL, n=1 (3.7%). The rates of complete remission for control group, bilateral group, and lymph node metastases group were: 63/65 (97%), 2/3 (67%, p<0.001), and 16/24(67%, p=0.128), respectively.
Patients with aggressive-variant ALCL had significantly longer time from diagnosis to definitive surgery, comparing to the control group (21 versus 8 months, p=0.039), and a lower rate of definitive surgery (59% versus 88%, p=0.004), respectively. The benefit of adjuvant chemotherapy and radiation for patients with advanced ALCL is not yet clearly defined, the researchers note.
The US Food and Drug Administration has also collaborated with the ASPS and The PSF to form the Patient Registry and Outcomes For breast Implants and anaplastic large cell Lymphoma etiology and Epidemiology (PROFILE) registry to prospectively track patients and outcomes.
“In conjunction with The PSF and the FDA, we have been conducting research and analyzing the incidence of BIA-ALCL to develop better understanding and effectively educate patients and physicians,” says study author Mark Clemens, MD, an assistant professor of Plastic Surgery at The University of Texas MD Anderson Cancer Center in Houston.