High dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) in primary breast lymphoma (PBL)

Lawrence Negret, Teresa C. Gentile, Sheila M. Lemke

Research output: Contribution to journalArticle

Abstract

Primary Breast Lymphomas (PBL) are very rare and constitute only 0.04-0.5% of tumors of the breast, 0.38-0.7% of all lymphomas, and 1.7-2.2% of all extranodal lymphomas. PBL has traditionally been treated in much the same way as Non-Hodgkin's lymphoma (NHL). The use of HDCT and ASCT in patients with recurrent NHL is well established but little is known in PBL. We recently treated a 39-year-old white female with PBL (stage IE, diffuse large B cell lymphoma) which presented as a mass of the left breast in 1998. She received 6 cycles of CHOP chemotherapy and achieved complete remission (CR). Two years later the disease recurred, this time isolated to the right breast. She was treated with one cycle of DHAC, and one cycle of high dose cytoxan with subsequent ASCT. At 90 days post transplant, she had no evidence of disease. Chemotherapy achieves CR in 44-87% of patients with NHL, while 40-70% remain disease free. In contrast, outcomes in recurrence of NHL with standard doses of salvage chemotherapy have been poor. A review of the literature yielded no data on PBL treated with HDCT followed by ASCT, though recent studies have demonstrated better outcomes for chemotherapy sensitive relapsed NHL in general. A question that still needs to be answered is whether patients with recurrent PBL will benefit from this treatment. It may be that the natural history of extranodal NHL and specifically PBL will lead to less favorable or different outcomes. PBL is uncommon, thus it will be difficult to study this on a large-scale basis and extrapolation from other NHL studies may be necessary. It is of importance, however, to consider other variables before ASCT. These include stage of disease, tumor burden, histologie type, and response to standard doses of chemotherapy. We believe that HOC and ASCT should be considered as a treatment alternative for selected patients with recurrent PBL.

Original languageEnglish
JournalBlood
Volume96
Issue number11 PART II
StatePublished - Dec 1 2000
Externally publishedYes

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Transplants
Chemotherapy
Stem cells
Lymphoma
Breast
Stem Cells
Drug Therapy
Non-Hodgkin's Lymphoma
Tumors
Salvaging
Extrapolation
Cyclophosphamide
Lymphoma, Large B-Cell, Diffuse
Cells
Tumor Burden
Breast Neoplasms

ASJC Scopus subject areas

  • Hematology

Cite this

High dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) in primary breast lymphoma (PBL). / Negret, Lawrence; Gentile, Teresa C.; Lemke, Sheila M.

In: Blood, Vol. 96, No. 11 PART II, 01.12.2000.

Research output: Contribution to journalArticle

Negret, Lawrence ; Gentile, Teresa C. ; Lemke, Sheila M. / High dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) in primary breast lymphoma (PBL). In: Blood. 2000 ; Vol. 96, No. 11 PART II.
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abstract = "Primary Breast Lymphomas (PBL) are very rare and constitute only 0.04-0.5{\%} of tumors of the breast, 0.38-0.7{\%} of all lymphomas, and 1.7-2.2{\%} of all extranodal lymphomas. PBL has traditionally been treated in much the same way as Non-Hodgkin's lymphoma (NHL). The use of HDCT and ASCT in patients with recurrent NHL is well established but little is known in PBL. We recently treated a 39-year-old white female with PBL (stage IE, diffuse large B cell lymphoma) which presented as a mass of the left breast in 1998. She received 6 cycles of CHOP chemotherapy and achieved complete remission (CR). Two years later the disease recurred, this time isolated to the right breast. She was treated with one cycle of DHAC, and one cycle of high dose cytoxan with subsequent ASCT. At 90 days post transplant, she had no evidence of disease. Chemotherapy achieves CR in 44-87{\%} of patients with NHL, while 40-70{\%} remain disease free. In contrast, outcomes in recurrence of NHL with standard doses of salvage chemotherapy have been poor. A review of the literature yielded no data on PBL treated with HDCT followed by ASCT, though recent studies have demonstrated better outcomes for chemotherapy sensitive relapsed NHL in general. A question that still needs to be answered is whether patients with recurrent PBL will benefit from this treatment. It may be that the natural history of extranodal NHL and specifically PBL will lead to less favorable or different outcomes. PBL is uncommon, thus it will be difficult to study this on a large-scale basis and extrapolation from other NHL studies may be necessary. It is of importance, however, to consider other variables before ASCT. These include stage of disease, tumor burden, histologie type, and response to standard doses of chemotherapy. We believe that HOC and ASCT should be considered as a treatment alternative for selected patients with recurrent PBL.",
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