letters to the editor |
Breast lymphoma
I read the interesting paper by Ryan et al. [1] that reported the experience in primary breast lymphoma (PBL) of the International Extranodal Lymphoma Study Group. I agree that PBL will be considered a different clinical entity when compared with nodal diffuse large B-cell lymphoma (DLBCL) and that the best treatment is limited surgery (biopsy), chemotherapy-based anthracycline and involved-field radiotherapy. However, as mentioned, progression-free survival and overall survival (OS) are poor in some groups of these patients. Taking into consideration that most cases of PBL are DBLCL and that they are CD20+, Ryan et al. suggest that the use of monoclonal antibody rituximab will be considered in the treatment of these patients.Recently, we reported a phase II study in 32 patients with PBL, in early stage (IE and IIE), mean age (45.9 years), 81% showing a low or low-intermediate international prognostic index (IPI), that were treated with dose dense chemotherapy (CEOP14), including rituximab 375 mg/m2, i.v., day 1, every day by six cycles, if patients achieved complete response, they received involved-field radiotherapy as reported [2]. Complete response was achieved in 28 cases (87%), and actuarial curves at 3 years showed that event-free survival was 75% and OS was 75%; these were not statistically different when compared with our historical controls. Patients who relapse die due to tumor progression. No relapse was observed in the central nervous system because our patients did not show adverse prognostic factors: high levels of lactic dehydrogenase and high clinical risk according to IPI.
Although treatment was well tolerated, with moderate acute toxicity, improvement was not observed when compared with historical groups. Multicentric, controlled clinical trials will be necessary to define the role of rituximab in PBL. However, PBL is a rare presentation of DLBCL, even in tertiary centers, thus it will probably be very difficult to begin this type of treatment. We conclude that rituximab did not improve outcome in PBL, in early stage disease and that other strategies, such as reinforcement or intensification of dose, should be considered in these patients.
Oncology Research Unit, IMSS, Colonia Doctores, México
* (E-mail: agustin.aviles{at}imss.gob.mx)
References
1. Ryan G, Mantelli G, Kuper-Hommer M, et al. Primary diffuse large B-cell lymphoma of the breast. Prognostic factors and outcome of a study by the International Extranodal Lymphoma Study Group. Ann Oncol. (2008) 19:233–241.
2. Avilés A, Castañeda C, Neri N, et al. Rituximab and dose dense chemotherapy in primary breast lymphoma. Haematologica (2007) 92:1147–1148.
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