Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma diagnosed in patients with a history of breast implants. Most patients develop a periprosthetic effusion at early stages of disease while less common presentations include a palpable mas...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical Publishers, Inc.
2025-01-01
|
| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2427-2066 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832591982281621504 |
|---|---|
| author | Marzia Salgarello Jaroslaw Krupa Rebecca Allchin Simon Pilgrim Fiona Miall Arianna Di Napoli Maurizio Martelli Giulio Tarantino |
| author_facet | Marzia Salgarello Jaroslaw Krupa Rebecca Allchin Simon Pilgrim Fiona Miall Arianna Di Napoli Maurizio Martelli Giulio Tarantino |
| author_sort | Marzia Salgarello |
| collection | DOAJ |
| description | Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma diagnosed in patients with a history of breast implants. Most patients develop a periprosthetic effusion at early stages of disease while less common presentations include a palpable mass, severe capsular contracture, lymphadenopathy, or cutaneous erythema. Due to the complex nature of this disease, a multidisciplinary approach is necessary for optimal management, particularly in locally advanced disease or inoperable patients. We present the successful use of neoadjuvant therapeutic protocols in two cases of locally advanced BIA-ALCL. The first case was a 52-year-old patient with a left breast mass-like stage III disease who underwent combined targeted immunotherapy and chemotherapy (brentuximab vedotin [BV]–cyclophosphamide, doxorubicin, prednisone [CHP]). Following a complete radiological and metabolic response, the patient underwent bilateral implant removal, right total intact capsulectomy, left en bloc capsulectomy, and skin resection from the left inframammary fold in continuity with the capsule. The second case was a 65-year-old patient with right breast swelling and mass-like stage IIA disease who received targeted immunotherapy, BV. Following a complete metabolic response, she underwent bilateral implant removal and en bloc capsulectomy. A literature review and the reported cases suggest the effectiveness of targeted immunotherapy as monotherapy or in combination with chemotherapy in locally advanced BIA-ALCL in disease downstaging, surgical de-escalation, reduction of significant postoperative complications, and an acceptable tolerance profile. Although surgery is an essential part of treatment, the timing and type of intervention should be carefully planned, especially when primary, radical resection is uncertain. |
| format | Article |
| id | doaj-art-2a692a4b831740eeae0f36e6418712f1 |
| institution | Kabale University |
| issn | 2234-6163 2234-6171 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj-art-2a692a4b831740eeae0f36e6418712f12025-01-21T23:42:09ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712025-01-01520101102010.1055/a-2427-2066Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell LymphomaMarzia Salgarello0https://orcid.org/0000-0003-0688-6634Jaroslaw Krupa1https://orcid.org/0000-0001-7603-7983Rebecca Allchin2Simon Pilgrim3https://orcid.org/0000-0001-9774-6826Fiona Miall4https://orcid.org/0000-0003-4073-3973Arianna Di Napoli5https://orcid.org/0000-0002-3159-5380Maurizio Martelli6https://orcid.org/0000-0003-1007-0339Giulio Tarantino7https://orcid.org/0000-0001-9569-097XDepartment of Plastic Surgery, Università Cattolica del Sacro Cuore, Rome, ItalyDepartment of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicester, United Kingdom of Great Britain and Northern IrelandDepartment of Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, Leicester, United Kingdom of Great Britain and Northern IrelandDepartment of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom of Great Britain and Northern IrelandDepartment of Haematology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom of Great Britain and Northern IrelandDepartment of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea University Hospital, Rome, ItalyGroup of Experts on BIA-ALCL, Istituto Superiore di Sanità, Roma, Lazio, ItalyDepartment of Plastic, Reconstructive, and Esthetic surgery, Università Cattolica del Sacro Cuore, Rome, ItalyBreast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma diagnosed in patients with a history of breast implants. Most patients develop a periprosthetic effusion at early stages of disease while less common presentations include a palpable mass, severe capsular contracture, lymphadenopathy, or cutaneous erythema. Due to the complex nature of this disease, a multidisciplinary approach is necessary for optimal management, particularly in locally advanced disease or inoperable patients. We present the successful use of neoadjuvant therapeutic protocols in two cases of locally advanced BIA-ALCL. The first case was a 52-year-old patient with a left breast mass-like stage III disease who underwent combined targeted immunotherapy and chemotherapy (brentuximab vedotin [BV]–cyclophosphamide, doxorubicin, prednisone [CHP]). Following a complete radiological and metabolic response, the patient underwent bilateral implant removal, right total intact capsulectomy, left en bloc capsulectomy, and skin resection from the left inframammary fold in continuity with the capsule. The second case was a 65-year-old patient with right breast swelling and mass-like stage IIA disease who received targeted immunotherapy, BV. Following a complete metabolic response, she underwent bilateral implant removal and en bloc capsulectomy. A literature review and the reported cases suggest the effectiveness of targeted immunotherapy as monotherapy or in combination with chemotherapy in locally advanced BIA-ALCL in disease downstaging, surgical de-escalation, reduction of significant postoperative complications, and an acceptable tolerance profile. Although surgery is an essential part of treatment, the timing and type of intervention should be carefully planned, especially when primary, radical resection is uncertain.http://www.thieme-connect.de/DOI/DOI?10.1055/a-2427-2066brentuximab vedotinbreast implant-associated anaplastic large cell lymphomabreast implantneoadjuvant therapycapsulectomy |
| spellingShingle | Marzia Salgarello Jaroslaw Krupa Rebecca Allchin Simon Pilgrim Fiona Miall Arianna Di Napoli Maurizio Martelli Giulio Tarantino Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma Archives of Plastic Surgery brentuximab vedotin breast implant-associated anaplastic large cell lymphoma breast implant neoadjuvant therapy capsulectomy |
| title | Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma |
| title_full | Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma |
| title_fullStr | Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma |
| title_full_unstemmed | Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma |
| title_short | Neoadjuvant Immunotherapy and De-escalation of Surgery in Locally Advanced Breast Implant-associated Anaplastic Large Cell Lymphoma |
| title_sort | neoadjuvant immunotherapy and de escalation of surgery in locally advanced breast implant associated anaplastic large cell lymphoma |
| topic | brentuximab vedotin breast implant-associated anaplastic large cell lymphoma breast implant neoadjuvant therapy capsulectomy |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-2427-2066 |
| work_keys_str_mv | AT marziasalgarello neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma AT jaroslawkrupa neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma AT rebeccaallchin neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma AT simonpilgrim neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma AT fionamiall neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma AT ariannadinapoli neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma AT mauriziomartelli neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma AT giuliotarantino neoadjuvantimmunotherapyanddeescalationofsurgeryinlocallyadvancedbreastimplantassociatedanaplasticlargecelllymphoma |