Primary breast lymphoma: a report of 20 cases

Limited data are available concerning treatment and outcome of primary lymp homa of the breast (PLB), especially after CHOP (cyclophosphamide, hydroxyd oxorubicin, vincristine, prednisone) chemotherapy. We retrospectively revie wed 20 consecutive cases of localized PLB seen at our institution over a 20 year period. All PLB were of B-cell origin: treatment was CHOP or a CHOP-n e regimen in all patients. Sixteen of the 20 patients achieved complete rem ission (CR) and two achieved partial remission (>75% tumour regression). Tw o patients had progressive disease on therapy. With a median follow-up of 5 4 months, six patients relapsed after 8-66 months. Two of the relapses invo lved the central nervous system (CNS) (isolated in one case, associated wit h other sites of relapse in the other). The two patients who achieved parti al remission also had progression in the CNS, 4 and 8 months after the end of CHOP chemotherapy. All four patients have died as a result of their dise ase 3, 6, 10 and 13 months after CNS relapse. Of the 16 centroblastic diffu se large B-cell lymphoma (DLCL), three had CNS disease at relapse. We also observed three (15%) controlateral breast relapses. Thirteen of the initial 20 patients are alive in CR, six patients have died as a result of their l ymphoma and one of unrelated disease. In conclusion, we observed a high inc idence of CNS relapse in this group of localized extranodal lymphoma, stron gly suggesting that CNS prophylaxis should be associated with systemic chem otherapy in localized PLB.