Clinical Scenario

This protocol addresses primary breast lymphoma arising in the setting of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) at stages IIB to IV, where macrotextured breast implants are present and regional lymph node involvement has been confirmed.

Approximately 15% of BIA-ALCL cases involve the regional lymph nodes. Stage IIB indicates a single regional lymph node affected; stage III, multiple regional lymph nodes; stage IV, disseminated spread across multiple lymph nodes and organs.

Treatment Approach

Management in this setting centres on a surgical approach targeting the capsule and the involved lymph nodes, combined with post-operative systemic or locoregional therapy; additional systemic options may be appropriate in specific patient profiles.

The complete therapeutic algorithm, sequencing, and patient-specific options are detailed in the full structured protocol below.

References

DOI: 10.1016/j.jpra.2022.01.004

Roughly, 15% of BIA-ALCL cases show lymph node involvement; stage IIB describes the involvement of a single regional lymph node; stage III describes the involvement of multiple regional lymph nodes; and stage IV describes the disseminated spread of BIA-ALCL to multiple lymph nodes and organs.
For patients with lymph node involvement (stage IIB-IV), full tumour regression has been achieved with full capsulectomy, lymph node dissection plus post-operative chemotherapy such as CHOP or localised radiation therapy to the lymph nodes.
Chemotherapy has also been given prior to capsulectomy in an attempt to reduce the tumour load before surgery and negate the requirement for lymph node dissection.
One case report described the successful use of 6 cycles of BV immunotherapy to treat BIA-ALCL which had invaded into the breast tissue and spread to the axillary lymph node.
BV may also be used in patients who have a history of breast cancer as repeated anthracycline-based therapy is not recommended in these cases.

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Treatment of Primary Breast Lymphoma in Breast Implant-Associated Anaplastic Large Cell Lymphoma (Stage IIB–IV) with Regional Lymph Node Involvement