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