Gholam D, Bibeau F, El Weshi A, Bosq J, Ribrag V
Department of Medicine, Institut Gustave Roussy, Villejuif, France.
Leuk Lymphoma. 2003 Jul;44(7):1173-8. doi: 10.1080/1042819031000079195.
Primary breast lymphoma (PBL) is a rare form of localized extranodal lymphoma. Few reports are available in the literature concerning its treatment and outcome. Of the 34 cases of PBL seen at our institution over a 25-year period, 20 consecutive cases were treated with CHOP or CHOP-like chemotherapy regimen and had adequate biopsy specimens for histological review. All these 20 PBL were of B-cell origin including one case of Burkitt lymphoma, and 2 cases of low-grade histologic type. Sixteen of the 20 patients achieved a complete remission (CR) and 2 achieved a partial remission (PR) (>75% tumor regression). Two patients had progressive disease while on therapy. With a median follow-up period of 80 months, 6 patients relapsed. Median time to relapse from diagnosis was 23 months (range, 3-41 months). Two of the relapses involved the central nervous system (CNS): isolated CNS relapse in one case and associated with other relapse sites in 1 case. The two patients who achieved a PR after chemotherapy also had disease progression to the CNS, 4 and 8 months after the end of CHOP chemotherapy. All 4 patients died of their disease 3, 6, 10 and 13 months after CNS involvement. Of the 16 centroblastic diffuse large B-cell lymphoma (DLCL), 3 had CNS disease at relapse. Three (15%) of our study patients developed a controlateral breast relapse. Twelve of the initial 20 patients were alive, including 11 with a persistent CR, 6 patients died of their lymphoma and 2 of unrelated diseases. In conclusion, we observed a high incidence of CNS relapse in this group of localized extranodal lymphoma, strongly suggesting that CNS prophylaxis should be associated with systemic chemotherapy in localized PLB.
原发性乳腺淋巴瘤（PBL）是一种罕见的局限性结外淋巴瘤。关于其治疗及预后，文献报道较少。在我们机构25年期间所见的34例PBL中，连续20例接受了CHOP或CHOP类似化疗方案治疗，且有足够的活检标本用于组织学检查。这20例PBL均为B细胞起源，包括1例伯基特淋巴瘤和2例低级别组织学类型。20例患者中有16例达到完全缓解（CR），2例达到部分缓解（PR）（肿瘤消退>75%）。2例患者在治疗期间病情进展。中位随访期为80个月，6例患者复发。从诊断到复发的中位时间为23个月（范围3 - 41个月）。其中2例复发累及中枢神经系统（CNS）：1例为孤立性CNS复发，1例与其他复发部位相关。化疗后达到PR的2例患者在CHOP化疗结束后4个月和8个月病情也进展至CNS。所有4例患者在CNS受累后3、6、10和13个月死于疾病。在16例中心母细胞性弥漫大B细胞淋巴瘤（DLCL）中，3例复发时有CNS疾病。我们研究中的3例（15%）患者出现对侧乳腺复发。最初20例患者中有12例存活，其中11例持续CR，6例死于淋巴瘤，2例死于无关疾病。总之，我们观察到这组局限性结外淋巴瘤中CNS复发的发生率较高，强烈提示在局限性PBL中，CNS预防应与全身化疗联合应用。
