Poor Prognosis of Diffuse Large B-Cell Lymphoma of the Breast: The Role of Dose-Dense Chemotherapy Primary breast lymphoma

Main Article Content

Agustin Aviles https://orcid.org/0000-0003-1872-2610
Luis Silva
Sergio Cleto https://orcid.org/0000-0002-1457-8773

Keywords

Diffuse large B-cell lymphoma, primary breast lymphoma, dose dense chemotherapy

Abstract

Background: The aim of the study was to define if the use of an intensive regimen (dose-dense) of chemotherapy may improve response rate and outcome in patients with primary breast lymphoma (PBL), whose is considered as lymphoma presentation with an worse prognosis.


Methods: Patients with pathological confirmed diagnosis of diffuse large B-cell lymphoma with clinical presentation on breast (PBL) , > 18 years old, stage I and II, negative for immunodeficient  syndrome, hepatitis A and B, previously untreated , with non-germinal center cell, were included in a open label clinical trial, phase II, were allocated to received an dose dense regimen of CHOP (cyclophosphamide , doxorubicine, vincristine and  prednisone)


Results:  Between July 2006 to December 2016, seventy eight patients were enrolled in the study. Complete response was achieved in 76 (94.4%), patients. Five patients relapse , thus progression free survival at 5 years was 94.0% (95 %  Confidence  interval (CI): 87% to 98%%): three patients achieved a second response and are alive, overall survival at 5-years was : 95.3 (96%CI: 89% to 102%).Relapse at  central nervous system has not been observed. Severe granulocytopenia was observed in  42.8  (93.0%) cycles, but no death associated to treatment were observed.


Conclusion: The use a dose-dense regimen of chemotherapy improve outcome in this setting of patients; although severe acute toxicities were frequent , it well controlled. Relapse in central nervous system has not been observed. Thus, we considered that dose-dense chemotherapy will be employed in this setting of patients.

References

1. Thomas A, Link RK, Altekruse S, Romiti A, Schoeder MS. Primary breast lymphoma in the United States. J Nat Cancer Inst 2012; 109;294djw. doi: 10.193/jnci/djw294.
2. Yhim HY, Kang HJ, Chus YH, Kim SJ, KIM WS, Kim JS, et al. Clinical outcomes and prognostic factors in patients with breast diffuse large B-cell lymphoma. BMC Cancer 2010;10:321. doi: 108186/1471-2407-10.321.
3. Jia Y, Sun G, Liu Z, Whang W, Zhou X. Primary breast diffuse large B-cell lymphoma. A population based study from 1975 to 2014. Oncotarget 2018; 9:3956.3907. doi: 10.18632/oncotarget.23285.
4. Hu S, Song Y, Sun X, Su L, Zhang W, Jia J, et al. Primary breast diffuse large B-cell lymphoma in the rituximab era: Therapeutic strategies and patterns of failure [published correction appears in Cancer Sci. 2019 Apr;110(4):1503]. Cancer Sci. 2018;109(12):3943-3952. doi:10.1111/cas.13828.
5. Ryan G, Martinelli C, Kuper-Hommel M, Tsang R, Pruneri G, Yuen K, et al. Primary diffuse large B-cell lymphoma of the breast. Prognosis factors and outcome of the study the Internartional Extranodal Lymphoma Study Group. Ann Oncol 2008; 19:233-241. doi: 10.1093/annoncol/mdm471.
6. Zhang T, Zhao H, Cui Z, Xu H, Liu X, Li Y, et al.: A multicentric retrospective study of primary breast diffuse large B-cell lymphoma and high-grade B-cell lymphoma treatment strategies and survival. Hematol 2020:25:203-210. doi 10.1080/1607-8454.2020/1769419.
7. Liu PP, Wang KF, Jin JT, Bi XW, Sun P, Wang Y, et al. Role of radiotherapy in primary breast lymphoma diffuse large B-cell lymphoma in the rituximab era. Cancer Med 2018:7;1895-1889. doi: 10.1002/cam4.1457.
8. Validare P, Capovilla M, Asscano B, Kroud Y, Goudefroy R, Planchet C, et al.: Primary breast non-Hodgkin lymphoma . Single center styydt of initial characteristics, natural history and prognostic factors. Am J Hematol 2009;84:133-139. doi: 10/1002/ajh.21353.
9. Hossein PJ, Maragulia JC, Salzberg MP, Press O, Habermann T, Vose JM et al.: A multicenter study of primary breast diffuse large B-cell lymphoma in the rituximab era. Br J Haematol 2014;105;359-363. doi: 10.1111/bjh.12753.
10. Aviles A, Delgado S, Nambo MJ, Neri N, Murillo E, Cleto S.: Primary breast lymphoma. Results of a controlled clinical trial. Oncology 2005;256-260. doi: 10.1159/00008833.
11. Aviles A, Nambo MJ, Neri N: Primary gastric diffuse large B-cell lymphoma. The role of dose-dense chemotherapy. J Oncol Pharm Practice 2019;25:1682-1686. doi:10.1177/1078115821.880454.
12. Cheson BD, Pfister B, Juweid ME, Gascoyne RD, Specht L, Horning S, et al. Revised response criteria for malignant lymphoma. J Clin Oncol 2007:576-586. doi: 10.1200/jco2006.29.2803.
13. Bataillard EI, Cheah CY, Maurer MJ, Khurana A, Eyre T, El-Galaly. Impact of R-CHOP intensity in survival outcome in diffuse large B-cell lymphoma. Blood Adv 2021; 5:2426-2436. doi 10.1182/bloodadvances.20211004655.
14. Aviles A, Castañeda C, Neri N, Nambo MJ. Rituximab and dose-dense chemotherapy in lymphoma primary of the breast. Haematologica 2007;92:1147-1148. doi 10.3324/hematol.1089.
15. Yhim HY, Yoon DH, Kim SJ, Yang DH, Eom HS, Kim KH, et al. First line treatment for primary breast diffuse large B-cell lymphoma using immunotherapy and central nervous system prophylaxis. Cancers 2020; 12:2192. doi 10/339/cancers1208219216.
16. Luo H, Yi P, Wang W, Li K, Meng L, Li J, et al. Clinicopathological Features, Treatment, and Prognosis in Primary Diffuse Large B Cell Lymphoma of the Breast: A Retrospective Study of 46 Patients. Med Sci Monit. 2019 Nov 17;25:8671-8682. doi: 10.12659/MSM.917550.

Article Statistics :Views : 46 | Downloads : 31 : 1