Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL) study

Ho-Young Yhim, Hye Jin Kang, Yoon Hee Choi, Seok Jin Kim, Won Seog Kim, Yee Soo Chae, Jin Seok Kim, Chul Won Choi, Sung Yong Oh, Hyeon Seok Eom, Jeong-A Kim, Jae Hoon Lee, Jong-Ho Won, Hyeok Shim, Je-Jung Lee, Hwa Jung Sung, Hyo Jung Kim, Dae Ho Lee, Cheolwon Suh, Jae-Yong Kwak, Ho-Young Yhim, Hye Jin Kang, Yoon Hee Choi, Seok Jin Kim, Won Seog Kim, Yee Soo Chae, Jin Seok Kim, Chul Won Choi, Sung Yong Oh, Hyeon Seok Eom, Jeong-A Kim, Jae Hoon Lee, Jong-Ho Won, Hyeok Shim, Je-Jung Lee, Hwa Jung Sung, Hyo Jung Kim, Dae Ho Lee, Cheolwon Suh, Jae-Yong Kwak

Abstract

Background: The breast is a rare extranodal site of non-Hodgkin lymphoma, and primary breast lymphoma (PBL) has been arbitrarily defined as disease localized to one or both breasts with or without regional lymph nodes involvement. The aim of this study was to evaluate the clinical outcomes in patients with diffuse large B cell lymphoma (DLBCL) and breast involvement, and to find the criteria of PBL reflecting the outcome and prognosis.

Methods: We retrospectively analyzed data from 68 patients, newly diagnosed with DLBCL and breast involvement at 16 Korean institutions between January 1994 and June 2009.

Results: Median age at diagnosis was 48 years (range, 20-83 years). Forty-three (63.2%) patients were PBL according to previous arbitrary criteria, sixteen (23.5%) patients were high-intermediate to high risk of international prognostic index. The patients with one extranodal disease in the breast (OED) with or without nodal disease were 49 (72.1%), and those with multiple extranodal disease (MED) were 19 (27.9%). During median follow-up of 41.5 months (range, 2.4-186.0 months), estimated 5-year progression-free survival (PFS) was 53.7 +/- 7.6%, and overall survival (OS) was 60.3 +/- 7.2%. The 5-year PFS and OS was significantly higher for patients with the OED group than those with the MED group (5-year PFS, 64.9 +/- 8.9% vs. 27.5 +/- 11.4%, p = 0.001; 5-year OS, 74.3 +/- 7.6% vs. 24.5 +/- 13.0%, p < 0.001). In multivariate analysis, MED (hazard ratio [HR], 3.61; 95% confidence interval [CI], 1.07-12.2) and fewer than four cycles of systemic chemotherapy with or without local treatments (HR, 4.47; 95% CI, 1.54-12.96) were independent prognostic factors for worse OS. Twenty-five (36.8%) patients experienced progression, and the cumulative incidence of progression in multiple extranodal sites or other than breasts and central nervous system was significantly different between the OED group and the MED group (5-year cumulative incidence, 9.7 +/- 5.4% vs. 49.0 +/- 15.1%, p = 0.001).

Conclusions: Our results show that the patients included in OED group, reflecting different treatment outcome, prognosis and pattern of progression, should be considered as PBL in the future trial. Further studies are warranted to validate our suggested criteria.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves of PFS (left) and OS (right) by each type of treatment in the OED group. (A) By number of cycles of systemic chemotherapy (fewer than four versus four or more); (B) the use of rituximab; (C) surgery, and (D) radiotherapy. Abbreviations: PFS, progression-free survival; OS, overall survival; OED, one extranodal disease in the breast.

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