RESUMO
PURPOSE: Breast implant-associated anaplastic large-cell lymphoma (BI-ALCL) is a rare type of T-cell lymphoma that arises around breast implants. The optimal management of this disease has not been established. The goal of this study is to evaluate the efficacy of different therapies used in patients with BI-ALCL to determine an optimal treatment approach. PATIENTS AND METHODS: In this study, we applied strict criteria to pathologic findings, assessed therapies used, and conducted a clinical follow-up of 87 patients with BI-ALCL, including 50 previously reported in the literature and 37 unreported. A Prentice, Williams, and Peterson model was used to assess the rate of events for each therapeutic intervention. RESULTS: The median and mean follow-up times were 45 and 30 months, respectively (range, 3 to 217 months). The median overall survival (OS) time after diagnosis of BI-ALCL was 13 years, and the OS rate was 93% and 89% at 3 and 5 years, respectively. Patients with lymphoma confined by the fibrous capsule surrounding the implant had better event-free survival (EFS) and OS than did patients with lymphoma that had spread beyond the capsule (P = .03). Patients who underwent a complete surgical excision that consisted of total capsulectomy with breast implant removal had better OS (P = .022) and EFS (P = .014) than did patients who received partial capsulectomy, systemic chemotherapy, or radiation therapy. CONCLUSION: Surgical management with complete surgical excision is essential to achieve optimal EFS in patients with BI-ALCL.
Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/etiologia , Neoplasias da Mama/cirurgia , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Gerenciamento Clínico , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Linfoma Anaplásico de Células Grandes/patologia , Linfoma Anaplásico de Células Grandes/terapia , Pessoa de Meia-Idade , Radioterapia Adjuvante , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Equine herpesvirus type 1 and 4 (EHV-1 and EHV-4) are important pathogens of horses worldwide. Infection with EHV-4 usually remains restricted to the upper respiratory tract, whereas infection with EHV-1 can generalize after leukocyte-associated viremia. Here we examined whether differences in the immunomodulatory glycoprotein G (gG) between the two viruses determine EHV-1's ability to cause systemic infection. To this end, mutant viruses were constructed based on the neurovirulent EHV-1 strain OH-03, in which the entire gG gene or parts thereof were exchanged with EHV-4 gG sequences. In vitro chemotaxis assays showed that supernatants of cells infected with the various gG mutant viruses interfered to variable degrees with neutrophil migration. More specifically, supernatants of cells infected with the gG deletion virus (vOH-ΔgG1) or OH-03 expressing EHV-4 gG (vOH-gG4) were unable to interfere with chemotaxis. Re-insertion of the predicted chemokine-binding region of EHV-1 gG in the vOH-gG4 mutant (vOH-gG4hyp1) did not completely restore the ability to inhibit neutrophil migration, whereas insertion of the hypervariable region of EHV-4 gG into vOH-03 (vOH-gG1hyp4) did not lead to a complete loss of chemokine-binding function. Very similar results were obtained in an in vivo study where the amount of neutrophils present in bronchioalveolar lavages (BALs) of mice infected with the different mutants was analyzed by flow cytometry. Taken together, our results show that, in a virus background, the hypervariable region is not solely responsible for the immunomodulatory potential of EHV-1 gG.