Clinical Characteristics and Prognostic Factors in Primary Breast Diffuse Large B-Cell Lymphoma

Abstract

Background Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare subtype of non-Hodgkin lymphoma (NHL) with limited data on the clinical features and prognostic factors. Patients and Methods A consecutive cohort of patients with PB-DLBCL was retrospectively analyzed in our hospital from February 1997 through July 2018. The primary endpoint is overall survival (OS) contributing to any cause. Results A total of 76 patients were diagnosed with PB-DLBCL. The median age at diagnosis was 51 years (range: 25-80 years), with female prevalence (98.7%). Forty (52.6%) patients had right-sided breast involvement but no bilateral breast involvement at diagnosis. Overall, disease stages IE and IIE were seen in 55 (72.4%) and 21 (27.6%) patients, respectively. According to the stage-modified International Prognostic Index (IPI), 37 (48.7%) patients were classified in the very good risk group (IPI 0). Of the 72 patients available, the non-germinal center B-cell (non-GCB) subtype of DLBCL was observed in 66 (91.6%) patients. All patients received anthracycline-based chemotherapy, 56 (73.7%) with rituximab, 31 (40.8%) also with additional radiation therapy, and 14 (18.4%) patients received a prophylactic intrathecal injection. Seven (9.2%) patients had refractory disease. With a median follow-up of 6.8 years (range 0.4-25.0 years), 10 (13.2%) patients had a relapse in the central nervous system (CNS) site. The 5-year and 10-year OS of all the patients was 97.2% (95% CI: 99.3-89.5) and 84.8% (95% CI: 70.0-93.5), respectively. The median OS was not reached. The median progression-free survival (PFS) was 10.3 years for patients with PB-DLBCL(Figure 2B). The 5-year PFS of all the patients was 76.3% (95% CI: 64.6-84.6). Univariate analysis revealed several prognostic factors, including stage-modified IPI, breast surgery, refractory disease, and CNS relapse. Multivariate analyses produced two independent prognostic factors for patients with PB-DLBCL, including stage-modified IPI score (2-3 versus 0) (hazard ratio: 19.114, 95% CI 1.841 to 198.451, p=0.013) and CNS relapse (hazard ratio: 5.522, 95% CI 1.059 to 28.788, p=0.043). Conclusion In our cohort, PB-DLBCL clinical features are similar to prior literature reports. Stage-modified IPI score and CNS relapse were associated with overall survival.

Clinicopathological characteristics, local treatment, and prognostic factors in IE/IIE primary breast lymphoma: a retrospective study of 67 patients

“…Jennings et al [ 14 ] suggested that mastectomy offered no benefit in the treatment of patients with PBL. Some have argued that breast surgery has been the method of choice for local control, and sufficient tissue samples were necessary for an accurate diagnosis [ 34 , 39 ]. A retrospective study from the International Extranodal Lymphoma Study Group reported that radical mastectomy increased the risk of death for patients with PBL, which might be associated with the postponement of chemotherapy caused by radical operations [ 6 ].…”

Predicting central nervous system relapse in primary breast diffuse large B-cell lymphoma using the stage-modified IPI score: A retrospective cohort study

“…Primary breast diffuse large B-cell lymphoma (DLBCL) represents a distinctive form of lymphoma primarily localized in one or both breasts, potentially involving regional lymph nodes such as ipsilateral axillary and/or supraclavicular lymph nodes [ 1 ]. Despite its primary breast origin, patients with this condition often face a heightened risk of central nervous system (CNS) relapse, with rates reaching up to 16% at the 10-year mark [ [2] , [3] , [4] , [5] ]. This complication is associated with an exceedingly poor prognosis in DLBCL [ [4] , [5] , [6] ].…”

“…Despite its primary breast origin, patients with this condition often face a heightened risk of central nervous system (CNS) relapse, with rates reaching up to 16% at the 10-year mark [ [2] , [3] , [4] , [5] ]. This complication is associated with an exceedingly poor prognosis in DLBCL [ [4] , [5] , [6] ]. Consequently, there is significant interest in identifying high-risk patients to tailor prophylactic therapies, with the goal of improving outcomes for DLBCL patients [ [2] , [3] , [4] , 7 ].…”

“…As a result, a reliable CNS recurrence prediction model based on available clinical data for primary breast DLBCL in routine clinical practice is still lacking. In our earlier research, we identified that both the stage-modified IPI score and CNS relapse independently influence the survival of patients with primary breast DLBCL [ 5 ]. Furthermore, the IPI score has proven useful in predicting survival in DLBCL, sharing remarkably similar clinical parameters with the CNS-IPI score.…”

“…Furthermore, the IPI score has proven useful in predicting survival in DLBCL, sharing remarkably similar clinical parameters with the CNS-IPI score. Meanwhile, the stage-modified IPI score serves as an independent prognostic factor in cases of primary breast DLBCL [ 5 ]. Indeed, individuals with stage IIE disease and higher IPI scores demonstrated an increased likelihood of developing CNS relapse in primary breast DLBCL [ 3 ].…”