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4439 Impact of Brentuximab Vedotin in Patients with Breast Implant–Associated Anaplastic Large Cell Lymphoma with Capsule Infiltration Requiring Chemotherapy

Program: Oral and Poster Abstracts
Session: 624. Hodgkin Lymphomas and T/NK cell Lymphomas: Clinical and Epidemiological: Poster III
Hematology Disease Topics & Pathways:
Clinical Practice (Health Services and Quality), Lymphomas, T Cell lymphoma, Diseases, Therapies, Lymphoid Malignancies
Monday, December 11, 2023, 6:00 PM-8:00 PM

David Sibon, MD, PhD1*, Jean Marc Schiano De Colella, MD2*, Emmanuel Itti, MD, PhD3*, Thu-Ha Dao, MD4*, Lucie Oberic, MD5*, Romain Ricci6*, Camille Laurent, MD, PhD7*, Luc Xerri, MD, PhD8*, Marc André, MD, PhD9*, Emmanuelle Nicolas Virelizier, MD10*, Christophe Bonnet, MD, PhD11*, Alexandre Karangwa, MD12*, Luc-Matthieu Fornecker, MD, PhD13*, Emmanuel Bachy, MD, PhD14*, Marie Bannier, MD15*, Alexandra Traverse-Glehen, MD, PhD16*, Youlia Kirova, MD, PhD17*, Cyrielle de Lacheisserie18*, Romain Ould-Ammar19*, Patrick Fogarty20*, Nadia Amara21*, Virginie Fataccioli22*, Hervé Tilly, MD23, Lionel Tortolano, PharmD, PhD24*, Romain Bosc, MD, PhD25*, Fabien Le Bras, MD1*, Philippe Gaulard, MD, PhD22* and Corinne Haioun, MD, PhD1

1Lymphoid Malignancies Department, Henri Mondor University Hospital, AP-HP, Créteil, France
2Institut Paoli-Calmettes, Marseille, France
3Nuclear medicine department, Henri Mondor University Hospital, AP-HP, Créteil, FRA
4Department of Radiology, Henri Mondor University Hospital, AP-HP, Créteil, France
5Hematology Department, IUCT - Oncopole, Toulouse, Toulouse, FRA
6LYSA-IM, Henri Mondor University Hospital, AP-HP, LYSARC, Créteil, FRA
7Pathology Department, Institut Universitaire du Cancer , Oncopole, Toulouse, France
8Pathology Department, Institut Paoli Calmettes, Marseille, FRA
9Department of Hematology, Saint-Luc - UCLouvain, Brussels, Belgium
10Hematology Department, Centre Léon Bérard, Lyon, FRA
11Hematology Department, CHU Liège, Liège, Belgium
12Hematology Department, Perpignan Hospital, Perpignan, France
13Hematology Department, Institut De Cancérologie Strasbourg Europe, Strasbourg, France
14Hematology Department, Lyon Sud Hospital, Pierre-Bénite, France
15Breast surgery department, Institut Paoli-Calmettes, Marseille, FRA
16Department of Pathology, Lyon Sud Hospital, Pierre Benite, France
17Radiation Therapy, Institut Curie, Paris, FRA
18LYSARC, Pierre Bénite, France
19Statistics Department, LYSARC, Pierre Bénite, France
20Statistics Department, LYSARC, Pierre Bénite, FRA
21Pathology Department, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
22Pathology Department, Henri Mondor University Hospital, AP-HP, Créteil, FRA
23Centre Henri-Becquerel, Rouen, France
24Department of Pharmacy, Henri Mondor University Hospital, AP-HP, Créteil, France
25Plastic and Reconstructive Surgery Department, Hôpital Européen Georges Pompidou, AP-HP, Paris, France

Background: Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon peripheral T-cell lymphoma most frequently arising around a textured surface breast implant. It has been shown that capsule infiltration (T2, T3 and T4 of the TNM staging system) was an adverse prognostic factor. In this context, chemotherapy (with or without brentuximab vedotin [BV]) may be proposed, considering other factors such as metastatic disease or incomplete resection. Furthermore, the need for adjuvant chemotherapy in patients with stage IIA (T4N0M0) and complete en-bloc excision without residual disease is debated.

Aim: To assess the management of BIA-ALCL with capsule infiltration, in particular: 1) To assess the impact of BV in those patients; 2) To evaluate the need for adjuvant chemotherapy in patients with stage IIA and complete en-bloc excision without residual disease.

Methods: Since 2016, a national multidisciplinary meeting has been implemented by the French National Cancer Institute (NCI) to optimize management of patients with BIA-ALCL, particularly those with advanced disease. Meanwhile, a national registry has been set up by the LYSA, in collaboration with health authorities. Central pathological review has been carried out within the French NCI-labeled Lymphopath network.

Results: From 2009 to 2023, 125 patients with BIA-ALCL were recorded, of which 111 (94 from France and 17 from Belgium) had complete data and were included in the present analysis. Overall, median age at diagnosis of BIA-ALCL was 58 years (24-82 years). Reasons for initial implantation were breast cancer reconstruction (n=54; 49%), cosmetic (n=45; 41%) or other (n=12; 10%). The median interval from first implantation to diagnosis of BIA-ALCL was 12.3 years (4-40 years). The median number of implants in the breast involved by BIA-ALCL was 2 (1-8), including at least one silicone implant in 95 (86%) patients, and at least one textured implant in all informative cases (n=102; Most often Allergan Biocell implants). At diagnosis of BIA-ALCL, 78/110 (71%) patients presented with periprosthetic effusion only, 20 (18%) had effusion and a breast mass, 6 (5.5%) had a breast mass only, and 6 (5.5%) had neither. At pathological examination of the capsule, T-stage was T1 (confined to effusion or a layer on luminal side of capsule) in 73/111 (66%) cases, T2-T3 (capsule infiltration) in 5 (4.5%) cases, T4 (lymphoma infiltrates beyond the capsule) in 32 (29%) cases, and unclassifiable in 1 case. Moreover, 18/111 (16%) patients had at least one non-breast extranodal involvement.

Among the 36 patients with capsule infiltration (5 T2-T3 and 31 T4), 13 (including 11 T4) were treated with BV-CH(E)P regimen, 12 (all T4) with a CHOP/CHOP-like regimen, and 11 (including 8 T4) did not receive any chemotherapy. The main reasons for receiving chemotherapy were metastatic disease, incomplete resection, or no surgery. Patients who did not receive chemotherapy had a localized disease (3 stage IB/IC and 8 stage IIA) with complete en-bloc excision and no residual disease. Patients treated with BV-CH(E)P regimen and CHOP/CHOP-like regimen had similar characteristics without significant differences regarding age, clinical presentation, stage and surgery. After a median follow-up of 47 months from BIA-ALCL diagnosis, for BV-CH(E)P and CHOP/CHOP-like groups, the respective 4-year PFS rates were 100% and 57% (p=0.01), and the respective 4-year OS rates were 100% and 73% (p=0.07). Regarding the 11 patients who did not receive chemotherapy, 4-year PFS and OS were both 75%, which corresponds to a single event being a death without progression occurring more than 3 years after the diagnosis of lymphoma (4-year lymphoma-specific survival was 100%).

Conclusions: 1) In patients with capsule infiltration requiring chemotherapy, BV-CH(E)P regimen was associated with improved PFS and OS compared with CHOP/CHOP-like regimen; 2) Patients with stage IIA and complete en-bloc excision without residual disease had favorable outcome without the need for adjuvant chemotherapy. These results should be confirmed prospectively.

Disclosures: Sibon: Roche: Consultancy; Janssen: Consultancy; AbbVie: Consultancy; Takeda: Consultancy. Schiano De Colella: Janssen, Sanofi, GSK, Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer, Amgen: Other: Accomodation. Oberic: roche: Honoraria; gilead: Honoraria; incyte: Honoraria; BMS: Honoraria; AZD: Honoraria. Laurent: Janssen Pharmaceuticals: Honoraria; F. Hoffmann-La Roche AG: Research Funding. Bachy: Kite, a Gilead Company: Honoraria, Other: Personal Fees; Roche: Consultancy, Honoraria; Amgen: Research Funding; Bristol Myers Squibb: Honoraria, Other: Personal Fees, Research Funding; Novartis: Honoraria, Other: Personal Fees; Incyte: Honoraria; Takeda: Honoraria; Pfizer: Honoraria, Other: Personal Fees; Hospices Civils de Lyon Claude Bernard Lyon 1 University: Current Employment.

OffLabel Disclosure: Brentuximab vedotin was used off-label in patients with BIA-ALCL.

*signifies non-member of ASH