An Updated Approach and Understanding of Breast Implant–Associated Anaplastic Large Cell Lymphoma

Authors:
Neha Mehta-Shah Division of Oncology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri; and

Search for other papers by Neha Mehta-Shah in
Current site
Google Scholar
PubMed
Close
 MD, MSCI
and
Paola Ghione Division of Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York.

Search for other papers by Paola Ghione in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a rare subtype of T-cell non-Hodgkin lymphoma that is usually localized to the fluid and capsule surrounding a breast implant. There have only been <1,000 cases and 36 deaths reported to date and the average patient presents 7 to 10 years following initial breast implant placement. Most patients present with delayed seromas, a breast mass, capsular abnormalities, lymphadenopathy, or cutaneous masses. Unlike other forms of non-Hodgkin lymphoma, most cases are cured with surgery alone. The challenge of BIA-ALCL surrounds its rarity—in regard to both its diagnosis as well as the limited available data to guide therapy for more advanced cases. Careful pathology evaluation to analyze both the fluid surrounding the capsule and the capsule itself is critical. Studies to identify which patients are at greater risk of development of this rare entity are ongoing.

Submitted December 13, 2021; accepted for publication January 13, 2022.

Disclosures: Dr Mehta-Shah has disclosed receiving grant/institutional research funding from AstraZeneca, Bristol Myers Squibb, C4 Therapeutics, Celgene, Corvus Pharmaceuticals, Daiichi Sankyo, Genentech/Roche, Innate Pharmaceuticals, Secura Bio, and Verstem; and serving as a consultant/advisory board member for C4 Therapeutics, Daiichi Sankyo, Karyopharm Therapeutics, Kyowa Hakko Kirin Co., Ltd., Ono Pharmaceuticals, and Secura Bio. Dr. Ghione has disclosed receiving grant/research support from Kite Pharma and serving as an advisory board member for AstraZeneca and Daiichi Sankyo.

Correspondence: Neha Mehta-Shah, MD, MSCI, Division of Oncology, Department of Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Box 8056, St. Louis, MO 63110. Email: mehta-n@wustl.edu
  • Collapse
  • Expand
  • 1.

    Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016;127:23752390.

  • 2.

    American Society of Plastic Surgeons. BIA-ALCL physician resources. Accessed January 17, 2022. Available at: https://www.plasticsurgery.org/for-medical-professionals/health-policy/bia-alcl-physician-resources

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Myckatyn TM, Mehta-Shah N, Duncavage E. Breast implant-associated anaplastic large cell lymphoma: real, rare, but avoidable. JAMA Surg 2020;155:34.

  • 4.

    Brody GS, Deapen D, Taylor CR, et al. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg 2015;135:695705.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    McCarthy CM, Loyo-Berrios N, Qureshi AA, et al. Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE): initial report of findings, 2012–2018. Plast Reconstr Surg 2019;143(3 Suppl):65S73S.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Doren EL, Miranda RN, Selber JC, et al. U.S. epidemiology of breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg 2017;139:10421050.

  • 7.

    Marra A, Viale G, Pileri SA, et al. Breast implant-associated anaplastic large cell lymphoma: a comprehensive review. Cancer Treat Rev 2020;84:101963.

  • 8.

    Quesada AE, Medeiros LJ, Clemens MW, et al. Breast implant-associated anaplastic large cell lymphoma: a review. Mod Pathol 2019;32:166188.

  • 9.

    Leberfinger AN, Behar BJ, Williams NC, et al. Breast implant-associated anaplastic large cell lymphoma: a systematic review. JAMA Surg 2017;152:11611168.

  • 10.

    de Jong D, Vasmel WL, de Boer JP, et al. Anaplastic large-cell lymphoma in women with breast implants. JAMA 2008;300:20302035.

  • 11.

    Vase MO, Friis S, Bautz A, et al. Breast implants and anaplastic large-cell lymphoma: a danish population-based cohort study. Cancer Epidemiol Biomarkers Prev 2013;22:21262129.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    de Boer M, van Leeuwen FE, Hauptmann M, et al. Breast implants and the risk of anaplastic large-cell lymphoma in the breast. JAMA Oncol 2018;4:335341.

  • 13.

    McGuire P, Reisman NR, Murphy DK. Risk factor analysis for capsular contracture, malposition, and late seroma in subjects receiving Natrelle 410 form-stable silicone breast implants. Plast Reconstr Surg 2017;139:19.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Ghione P, Cordeiro PG, Ni A, et al. Risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in a cohort of 3,546 women prospectively followed after receiving textured breast implants [abstract]. J Clin Oncol 2019;37(Suppl):Abstract 1565.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    de Boer M, Hauptmann M, Hijmering NJ, et al. Increased prevalence of BRCA1/2 mutations in women with macrotextured breast implants and anaplastic large cell lymphoma of the breast. Blood 2020;136:13681372.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Clemens MW, Nava MB, Rocco N, et al. Understanding rare adverse sequelae of breast implants: anaplastic large-cell lymphoma, late seromas, and double capsules. Gland Surg 2017;6:169184.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Maxwell GP, Van Natta BW, Bengtson BP, et al. Ten-year results from the Natrelle 410 anatomical form-stable silicone breast implant core study. Aesthet Surg J 2015;35:145155.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Di Napoli A, Pepe G, Giarnieri E, et al. Cytological diagnostic features of late breast implant seromas: from reactive to anaplastic large cell lymphoma. PLoS One 2017;12:e0181097.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Grady D, Rabin RC. Reports of breast implant illnesses prompt federal review. New York Times. March 20, 2019. Accessed January 3, 2022. Available at: https://www.nytimes.com/2019/03/19/health/breast-implants-fda-sick.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Dunn L, Nguyen V, Pawloski A. Doctors, patients warn about cancer linked to textured breast implants. Transcript. NBC News. NBC television. July 22, 2019. Accessed January 3, 2022. Available at: https://www.today.com/health/doctors-patients-warn-about-cancer-linked-textured-breast-implants-t159273

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Loch-Wilkinson A, Beath KJ, Knight RJW, et al. Breast implant-associated anaplastic large cell lymphoma in Australia and New Zealand: high-surface-area textured implants are associated with increased risk. Plast Reconstr Surg 2017;140:645654.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. Accessed December 29, 2017. Available at: https://www.nvpc.nl/uploads/stand/NVPC110126DOC-FN-ASPS_Final_ALCL_White_Paper_Clean_Version_1-18-1177.pdf

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Groth AK, Graf R. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and the textured breast implant crisis. Aesthetic Plast Surg 2020;44:112.

  • 24.

    Jaffe ES, Ashar BS, Clemens MW, et al. Best practices guideline for the pathologic diagnosis of breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol 2020;38:11021111.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Ghosh T, Duncavage E, Mehta-Shah N, et al. A cautionary tale and update on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Aesthet Surg J 2020;40:12881300.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Laurent C, Delas A, Gaulard P, et al. Breast implant-associated anaplastic large cell lymphoma: two distinct clinicopathological variants with different outcomes. Ann Oncol 2016;27:306314.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Clemens MW, Jacobsen ED, Horwitz SM. 2019 NCCN consensus guidelines on the diagnosis and treatment of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Aesthet Surg J 2019;39(Suppl 1):S313.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Horwitz SM, Ansell S, Ai WZ, et al. NCCN Clinical Practice Guidelines in Oncology: T-Cell Lymphoma. Version 1.2022. Accessed January 18, 2022. To view the most recent version, visit NCCN.org

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Clemens MW, Horwitz SM. NCCN consensus guidelines for the diagnosis and management of breast implant-associated anaplastic large cell lymphoma. Aesthet Surg J 2017;37:285289.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Feeney J, Horwitz S, Gönen M, et al. Characterization of T-cell lymphomas by FDG PET/CT. AJR Am J Roentgenol 2010;195:333340.

  • 31.

    Miranda RN, Aladily TN, Prince HM, et al. Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. J Clin Oncol 2014;32:114120.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Clemens MW, Medeiros LJ, Butler CE, et al. Complete surgical excision is essential for the management of patients with breast implant-associated anaplastic large-cell lymphoma. J Clin Oncol 2016;34:160168.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Collins MS, Miranda RN, Medeiros LJ, et al. Characteristics and treatment of advanced breast implant-associated anaplastic large cell lymphoma. Plast Reconstr Surg 2019;143(3 Suppl):41S50S.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Alderuccio JP, Desai A, Yepes MM, et al. Frontline brentuximab vedotin in breast implant-associated anaplastic large-cell lymphoma. Clin Case Rep 2018;6:634637.

  • 35.

    Horwitz S, O’Connor OA, Pro B, et al. Brentuximab vedotin with chemotherapy for CD30-positive peripheral T-cell lymphoma (ECHELON-2): a global, double-blind, randomised, phase 3 trial. Lancet 2019;393:229240.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Richardson K, Alrifai T, Grant-Szymanski K, et al. Breast implant-associated anaplastic large-cell lymphoma and the role of brentuximab vedotin (SGN-35) therapy: a case report and review of the literature. Mol Clin Oncol 2017;6:539542.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Allchin RL, Wickenden K, Pilgrim S, et al. The successful use of neo adjuvant brentuximab vedotin in the treatment of BIA-ALCL. HemaSphere 2020;4:e501.

  • 38.

    Blombery P, Thompson ER, Jones K, et al. Whole exome sequencing reveals activating JAK1 and STAT3 mutations in breast implant-associated anaplastic large cell lymphoma anaplastic large cell lymphoma. Haematologica 2016;101:e387390.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Laurent C, Nicolae A, Laurent C, et al. Gene alterations in epigenetic modifiers and JAK-STAT signaling are frequent in breast implant-associated ALCL. Blood 2020;135:360370.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Di Napoli A, Jain P, Duranti E, et al. Targeted next generation sequencing of breast implant-associated anaplastic large cell lymphoma reveals mutations in JAK/STAT signalling pathway genes, TP53 and DNMT3A. Br J Haematol 2018;180:741744.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Quesada AE, Zhang Y, Ptashkin R, et al. Next generation sequencing of breast implant-associated anaplastic large cell lymphomas reveals a novel STAT3-JAK2 fusion among other activating genetic alterations within the JAK-STAT pathway. Breast J 2021;27:314321.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 5838 797 167
PDF Downloads 2964 346 28
EPUB Downloads 0 0 0