Primary breast diffuse large B-cell lymphoma: a report of 21 cases / 中国肿瘤临床

ABSTRACT

Objective: To investigate the clinical characteristics, treatment regimens, and outcomes of patients with primary breast dif-fuse large B-cell lymphoma (PB-DLBCL). Methods: Between January 2010 and January 2018, 21 patients with PB-DLBCL were diag-nosed, treated, and followed up at the First Affiliated Hospital of Zhengzhou University. All patients were female, with a median age of 49 years (ranging from 21 to 77 years) at presentation. All patients received chemotherapy, of which 17 patients received the CHOP regimen and 4 received the EPOCH regimen. Eight patients received chemotherapy followed by radiotherapy, and 13 received chemo-therapy alone. Six patients received prophylactic intrathecal injections. The incidences of refractory and progressive disease between patients who received different regimens were analyzed using the Chi-square test. The overall survival (OS) and progression-free sur-vival (PFS) rates were calculated using the Kaplan-Meier method, and differences in survival were compared using the Log-rank test. Multivariate analysis was performed with the Cox-regression model for those factors that were confirmed as significant in the univari-ate analysis. Results: The most common presentation was a painless mass. The 5-year OS and PFS rates were 74% and 66%, respective-ly. There was no significant difference in the incidence of refractory or progressive disease between the EPOCH and CHOP groups (P=0.603). Six of those who received prophylactic intrathecal injections had no central nervous system recurrence, and 2 patients who did not receive prophylactic intrathecal injections had central nervous system recurrence. Univariate and multivariate analyses showed that both the level of serum β2 microglobulin [P=0.044, hazard ratio (HR)=0.431, 95% confidence interval (CI): 0.432-0.967] and radio-therapy (P=0.002, HR=0.495, 95% CI: 1.073-2.508) were related to the OS of PB-DLBCL. Conclusions: PB-DLBCL often occurs in women, mostly involving the unilateral breast, which manifests mainly as a painless mass. The level of serum β2 microglobulin is a factor of poor prognosis in PB-DLBCL. The treatment modality of chemotherapy combined with radiotherapy can significantly improve the OS of PB-DLBCL. Prophylactic intrathecal injections may be useful to reduce the incidence of refractory disease or recurrence in the central nervous system.