Poor Prognosis of Diffuse Large B-Cell Lymphoma of the Breast: The Role of Dose-Dense Chemotherapy

The aim of the study was to determine if the use of an intensive regimen (dose-dense) of chemotherapy may improve the response rate and outcome in patients with primary breast lymphoma (PBL), which is considered as lymphoma presentation with a poor prognosis.

Patients with pathologically confirmed diagnosis of diffuse large B-cell lymphoma with clinical presentation in the breast (PBL), > 18 years old, stage I and II, negative for immunodeficient syndrome, hepatitis A and B, previously untreated, and having non-germinal center cells were included in an open label clinical trial. Phase II patients received a dose dense regimen of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone).

Between July 2006 and December 2016, seventy-eight patients were enrolled in the study. Complete response was achieved in 76 (94.4%) patients. Five patients relapsed, so progression free survival at 5 years was 94.0% (95% confidence interval (CI: 87% to 98%%): three patients achieved a second response and are alive; the overall survival at 5-years was 95.3 (96% CI: 89% to 102%). Relapse at central nervous system has not been observed. Severe granulocytopenia was observed in 42.8 (93.0%) cycles, but no death associated with treatment was observed.

The use of a dose-dense regimen of chemotherapy improved the outcome in these patients; although severe acute toxicities were frequent, they were well-controlled. Relapse in central nervous system was not observed. Thus, we considered that dose-dense chemotherapy should be employed for this group of patients.