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Pat Whitworth MD/

ALCL Urgent Update from Dr Mark Clemens - ABS, Belfast May 2017

As most BCN members and readers know, last week the NYT published a front page story about anaplastic large cell lymphoma (ALCL) in women with breast implants, including implants placed for reconstruction after breast cancer surgery. A second full page article provided advice for women with implants.

Of course this led to unavoidable panic for many women and made many clinic visits and discussions much more intense and fraught this past week.

 

Very fortunately, the plastic surgeon featured in the articles, Dr Mark Clemens of MDACC, presented a comprehensive clinical update on ALCL at the Association for Breast Surgery Conference in Belfast within 48 hours of the NYT reports.

You can expect more links and references to Dr Clemens' essentially definitive presentation at the ABS, but I caught up with him at the meeting and here are the urgent take away points for today:

  1. Diagnosis starts with needle aspiration (no intraoperative diagnosis) of a substantial, persisting, peri-prosthetic fluid collection. The specimen is sent for screening with a request for CD30 staining. This is a screening test. CD30+ cells can be present in small amounts in perfectly healthy peri-prosthetic fluid. Further evaluation by an experienced pathologist is required to confirm the diagnosis.
  2. No confirmed cases in smooth implants (most textured implants use a process called "Biocell Salt loss" which might or might not be related).
  3. IF it happens, ALCL is a surgical disease and cured by complete oncologic removal of the capsule and any additional tumor in almost all cases.
  4. If systemic treatment is absolutely needed for unresectable disease: No CHOP, NO chemo. Treatment is brentuximab which targets CD30. Complete pathologic responses have been reported with brentuximab (one patient is now disease free after being sent to hospice after failed chemo - before brentuximab effectiveness was known).
  5. Those ALCL patients who have had capsulectomy and immediate implant replacement with smooth implants are all doing well with no evidence of disease.
    More to come from Dr Clemens' presentation (as in the screen shot above) soon.
    Bottom line for me for now: risk of death from ALCL for implant patients is far less than risk of death in a car on the way to the doctor's office.

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