CLINICAL CHARACTERISTICS AND PROGNOSTIC FACTORS IN PRIMARY BREAST DIFFUSE LARGE B-CELL LYMPHOMA

Main Article Content

guangliang Chen
Dou-dou Li
Sufen Sufen
Shiyu Jiang
Qunling Zhang
jia jin
Zuguang Xia
Yizhen Liu
Xiaojian Liu
Yanzhe Zhu
Yu Chen
Lingli Gu
Xiaonan Hong
Junning Cao
Rong Tao
Fangfang Lv

Keywords

Diffuse large B-cell lymphoma, Breast, Prognostic factors, Relapse, Central nervous system

Abstract

Background


Primary breast diffuse large B-cell lymphoma (PB-DLBCL) is a rare subtype of non-Hodgkin lymphoma (NHL) with limited data on the clinical features and prognostic factors.


Patients and Methods


A consecutive cohort of patients with PB-DLBCL was retrospectively analyzed in our hospital from February 1997 through July 2018. The primary endpoint is overall survival (OS) contributing to any cause.


Results


A total of 76 patients were diagnosed with PB-DLBCL. The median age at diagnosis was 51 years (range: 25-80 years), with female prevalence (98.7%). Forty (52.6%) patients had right-sided breast involvement but no bilateral breast involvement at diagnosis. Overall, disease stages IE and IIE were seen in 55 (72.4%) and 21 (27.6%) patients, respectively. According to the stage-modified International Prognostic Index (IPI), 37 (48.7%) patients were classified in the very good risk group (IPI 0). Of the 72 patients available, the non-germinal center B-cell (non-GCB) subtype of DLBCL was observed in 66 (91.6%) patients. All patients received anthracycline-based chemotherapy, 56 (73.7%) with rituximab, 31 (40.8%) also with additional radiation therapy, and 14 (18.4%) patients received a prophylactic intrathecal injection. Seven (9.2%) patients had refractory disease. With a median follow-up of 6.8 years (range 0.4-25.0 years), 10 (13.2%) patients had a relapse in the central nervous system (CNS) site. The 5-year and 10-year OS of all the patients was 97.2% (95% CI: 99.3-89.5) and 84.8% (95% CI: 70.0-93.5), respectively. The median OS was not reached. The median progression-free survival (PFS) was 10.3 years for patients with PB-DLBCL(Figure 2B). The 5-year PFS of all the patients was 76.3% (95% CI: 64.6-84.6). Univariate analysis revealed several prognostic factors, including stage-modified IPI, breast surgery, refractory disease, and CNS relapse. Multivariate analyses produced two independent prognostic factors for patients with PB-DLBCL, including stage-modified IPI score (2-3 versus 0) (hazard ratio: 19.114, 95% CI 1.841 to 198.451, p=0.013) and CNS relapse (hazard ratio: 5.522, 95% CI 1.059 to 28.788, p=0.043).


Conclusion


In our cohort, PB-DLBCL clinical features are similar to prior literature reports. Stage-modified IPI score and CNS relapse were associated with overall survival.

Downloads

Download data is not yet available.


Abstract 408
PDF Downloads 413
HTML Downloads 149

References

[1] C. Wiseman, and K.T. Liao, Primary lymphoma of the breast. Cancer 29 (1972) 1705-12.https://www.ncbi.nlm.nih.gov/pubmed/4555557
[2] P.J. Hosein, J.C. Maragulia, M.P. Salzberg, O.W. Press, T.M. Habermann, J.M. Vose, M. Bast, R.H. Advani, R. Tibshirani, A.M. Evens, N. Islam, J.P. Leonard, P. Martin, A.D. Zelenetz, and I.S. Lossos, A multicentre study of primary breast diffuse large B-cell lymphoma in the rituximab era. Br J Haematol 165 (2014) 358-63.https://www.ncbi.nlm.nih.gov/pubmed/24467658
[3] W. Jeanneret-Sozzi, A. Taghian, R. Epelbaum, P. Poortmans, D. Zwahlen, B. Amsler, S. Villette, Y. Belkacémi, T. Nguyen, P. Scalliet, P. Maingon, C. Gutiérrez, P. Gastelblum, M. Krengli, R.A. Raad, M. Ozsahin, and R.-O. Mirimanoff, Primary breast lymphoma: Patient profile, outcome and prognostic factors. A multicentre Rare Cancer Network study. BMC Cancer 8 (2008)
[4] G. Ryan, G. Martinelli, M. Kuper-Hommel, R. Tsang, G. Pruneri, K. Yuen, D. Roos, A. Lennard, L. Devizzi, S. Crabb, D. Hossfeld, G. Pratt, M. Dell’Olio, S.P. Choo, R.G. Bociek, J. Radford, S. Lade, A.M. Gianni, E. Zucca, F. Cavalli, and J.F. Seymour, Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Annals of Oncology 19 (2008) 233-241
[5] W.C. Jennings, R.S. Baker, S.S. Murray, C.A. Howard, D.E. Parker, L.F. Peabody, H.M. Vice, W.W. Sheehan, and T.A. Broughan, Primary breast lymphoma: the role of mastectomy and the importance of lymph node status. Ann Surg 245 (2007) 784-9.https://www.ncbi.nlm.nih.gov/pubmed/17457172
[6] G. Ryan, G. Martinelli, M. Kuper-Hommel, R. Tsang, G. Pruneri, K. Yuen, D. Roos, A. Lennard, L. Devizzi, S. Crabb, D. Hossfeld, G. Pratt, M. Dell'Olio, S.P. Choo, R.G. Bociek, J. Radford, S. Lade, A.M. Gianni, E. Zucca, F. Cavalli, J.F. Seymour, and G. International Extranodal Lymphoma Study, Primary diffuse large B-cell lymphoma of the breast: prognostic factors and outcomes of a study by the International Extranodal Lymphoma Study Group. Ann Oncol 19 (2008) 233-41.https://www.ncbi.nlm.nih.gov/pubmed/17932394
[7] P. Validire, M. Capovilla, B. Asselain, Y. Kirova, R. Goudefroye, C. Plancher, A. Fourquet, M. Zanni, P. Gaulard, A. Vincent-Salomon, and D. Decaudin, Primary breast non-Hodgkin's lymphoma: a large single center study of initial characteristics, natural history, and prognostic factors. Am J Hematol 84 (2009) 133-9.https://www.ncbi.nlm.nih.gov/pubmed/19199367
[8] H. Shen, Z. Wei, D. Zhou, Y. Zhang, X. Han, W. Wang, L. Zhang, C. Yang, and J. Feng, Primary extra-nodal diffuse large B-cell lymphoma: A prognostic analysis of 141 patients. Oncol Lett 16 (2018) 1602-1614.https://www.ncbi.nlm.nih.gov/pubmed/30008843
[9] J. Caon, E.S. Wai, J. Hart, C. Alexander, P.T. Truong, L.H. Sehn, and J.M. Connors, Treatment and Outcomes of Primary Breast Lymphoma. Clinical Breast Cancer 12 (2012) 412-419
[10] D. Li, J. Deng, H. He, Y. Bu, F. Peng, X. Tang, B. Wang, Y. Lei, H. Zhang, and P. Xie, Primary breast diffuse large B-cell lymphoma shows an activated B-cell–like phenotype. Annals of Diagnostic Pathology 16 (2012) 335-343
[11] S. Yoshida, N. Nakamura, Y. Sasaki, S. Yoshida, M. Yasuda, H. Sagara, T. Ohtake, S. Takenoshita, and M. Abe, Primary breast diffuse large B-cell lymphoma shows a non-germinal center B-cell phenotype. Modern Pathology 18 (2004) 398-405
[12] H.-Y. Yhim, H.J. Kang, Y.H. Choi, S.J. Kim, W.S. Kim, Y.S. Chae, J.S. Kim, C.W. Choi, S.Y. Oh, H.S. Eom, J.-A. Kim, J.H. Lee, J.-H. Won, H. Shim, J.-J. Lee, H.J. Sung, H.J. Kim, D.H. Lee, C. Suh, and J.-Y. Kwak, Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL) study. BMC Cancer 10 (2010)
[13] A. Thomas, B.K. Link, S. Altekruse, P.A. Romitti, and M.C. Schroeder, Primary Breast Lymphoma in the United States: 1975–2013. JNCI: Journal of the National Cancer Institute 109 (2017)
[14] Y. Jia, C. Sun, Z. Liu, W. Wang, and X. Zhou, Primary breast diffuse large B-cell lymphoma: a population-based study from 1975 to 2014. Oncotarget 9 (2017) 3956-3967
[15] D. Kang, S.E. Yoon, D. Shin, J. Lee, Y.S. Hong, S.K. Lee, J.E. Lee, Y.H. Park, J.S. Ahn, E. Guallar, W.S. Kim, J. Lee, S.J. Kim, and J. Cho, Risk of non-Hodgkin lymphoma in breast cancer survivors: a nationwide cohort study. Blood Cancer Journal 11 (2021)
[16] R. Schmitz, G.W. Wright, D.W. Huang, C.A. Johnson, J.D. Phelan, J.Q. Wang, S. Roulland, M. Kasbekar, R.M. Young, A.L. Shaffer, D.J. Hodson, W. Xiao, X. Yu, Y. Yang, H. Zhao, W. Xu, X. Liu, B. Zhou, W. Du, W.C. Chan, E.S. Jaffe, R.D. Gascoyne, J.M. Connors, E. Campo, A. Lopez-Guillermo, A. Rosenwald, G. Ott, J. Delabie, L.M. Rimsza, K. Tay Kuang Wei, A.D. Zelenetz, J.P. Leonard, N.L. Bartlett, B. Tran, J. Shetty, Y. Zhao, D.R. Soppet, S. Pittaluga, W.H. Wilson, and L.M. Staudt, Genetics and Pathogenesis of Diffuse Large B-Cell Lymphoma. New England Journal of Medicine 378 (2018) 1396-1407
[17] G.W. Wright, D.W. Huang, J.D. Phelan, Z.A. Coulibaly, S. Roulland, R.M. Young, J.Q. Wang, R. Schmitz, R.D. Morin, J. Tang, A. Jiang, A. Bagaev, O. Plotnikova, N. Kotlov, C.A. Johnson, W.H. Wilson, D.W. Scott, and L.M. Staudt, A Probabilistic Classification Tool for Genetic Subtypes of Diffuse Large B Cell Lymphoma with Therapeutic Implications. Cancer Cell 37 (2020) 551-568.e14
[18] K. Taniguchi, K. Takata, S.S. Chuang, T. Miyata-Takata, Y. Sato, A. Satou, Y. Hashimoto, M. Tamura, K. Nagakita, N. Ohnishi, M. Noujima-Harada, T. Tabata, Y.Y. Kikuti, Y. Maeda, N. Nakamura, M. Tanimoto, and T. Yoshino, Frequent MYD88 L265P and CD79B Mutations in Primary Breast Diffuse Large B-Cell Lymphoma. Am J Surg Pathol 40 (2016) 324-34.https://www.ncbi.nlm.nih.gov/pubmed/26752547
[19] K. Taniguchi, K. Takata, S.-S. Chuang, T. Miyata-Takata, Y. Sato, A. Satou, Y. Hashimoto, M. Tamura, K. Nagakita, N. Ohnishi, M. Noujima-Harada, T. Tabata, Y.Y. Kikuti, Y. Maeda, N. Nakamura, M. Tanimoto, and T. Yoshino, Frequent MYD88 L265P and CD79B Mutations in Primary Breast Diffuse Large B-Cell Lymphoma. American Journal of Surgical Pathology 40 (2016) 324-334
[20] R. Chen, D. Zhou, L. Wang, L. Zhu, and X. Ye, MYD88L265P and CD79B double mutations type (MCD type) of diffuse large B-cell lymphoma: mechanism, clinical characteristics, and targeted therapy. Therapeutic Advances in Hematology 13 (2022) 204062072110728
[21] W.H. Wilson, R.M. Young, R. Schmitz, Y. Yang, S. Pittaluga, G. Wright, C.-J. Lih, P.M. Williams, A.L. Shaffer, J. Gerecitano, S. de Vos, A. Goy, V.P. Kenkre, P.M. Barr, K.A. Blum, A. Shustov, R. Advani, N.H. Fowler, J.M. Vose, R.L. Elstrom, T.M. Habermann, J.C. Barrientos, J. McGreivy, M. Fardis, B.Y. Chang, F. Clow, B. Munneke, D. Moussa, D.M. Beaupre, and L.M. Staudt, Targeting B cell receptor signaling with ibrutinib in diffuse large B cell lymphoma. Nature Medicine 21 (2015) 922-926
[22] H.-Y. Yhim, J.S. Kim, H.J. Kang, S.J. Kim, W.S. Kim, C.W. Choi, H.S. Eom, J.-A. Kim, J.H. Lee, J.H. Won, H. Shim, J. Huh, D.-H. Lee, C. Suh, and J.-Y. Kwak, Matched-pair analysis comparing the outcomes of primary breast and nodal diffuse large B-cell lymphoma in patients treated with rituximab plus chemotherapy. International Journal of Cancer 131 (2012) 235-243
[23] H.Y. Yhim, D.H. Yoon, S.J. Kim, D.H. Yang, H.S. Eom, K.H. Kim, Y. Park, J.S. Kim, H.J. Kim, C. Suh, W.S. Kim, and J.Y. Kwak, First-Line Treatment for Primary Breast Diffuse Large B-Cell Lymphoma Using Immunochemotherapy and Central Nervous System Prophylaxis: A Multicenter Phase 2 Trial. Cancers (Basel) 12 (2020).https://www.ncbi.nlm.nih.gov/pubmed/32781541
[24] H. Shen, Z. Wei, D. Zhou, Y. Zhang, X. Han, W. Wang, L. Zhang, C. Yang, and J. Feng, Primary extra‑nodal diffuse large B‑cell lymphoma: A prognostic analysis of 141 patients. Oncology Letters (2018)
[25] Y. Sun, L.-M. Xu, X. Chen, D. Qian, J.-Q. You, Z. Yuan, and M. Joks, Diffuse large B-cell lymphoma of the breast: prognostic factors and treatment outcomes. OncoTargets and Therapy (2016) 2069
[26] S. Hu, Y. Song, X. Sun, L. Su, W. Zhang, J. Jia, O. Bai, S. Yang, R. Liang, X. Li, H. Zhang, Y. Gao, W. Zhang, X. Xiao, H. Bao, N. Wang, H. Ren, X. Cen, S.e. Yang, Y. Zhao, Y. Wang, Y. Wang, A. Liu, J. Wang, Y. Shi, M. Yuan, Y. Li, and X. He, Primary breast diffuse large B‐cell lymphoma in the rituximab era: Therapeutic strategies and patterns of failure. Cancer Science 109 (2018) 3943-3952
[27] X. Sun, B. Xu, Y. Li, J. Du, L. Dong, X. Gao, G. Li, X. Wei, and Y. Song, Primary breast diffuse large B-cell lymphoma-report of 21 cases from China with literatures review. Zhonghua Xue Ye Xue Za Zhi 36 (2015) 853-7.https://www.ncbi.nlm.nih.gov/pubmed/26477765
[28] Y.H. Zhu, W.J. Meng, L.H. He, Y.S. Jia, and Z.S. Tong, Prognosis analysis of primary breast diffuse large B cell lymphoma. Zhonghua Zhong Liu Za Zhi 41 (2019) 235-240.https://www.ncbi.nlm.nih.gov/pubmed/30917462
[29] A. Aviv, T. Tadmor, and A. Polliack, Primary diffuse large B-cell lymphoma of the breast: looking at pathogenesis, clinical issues and therapeutic options. Ann Oncol 24 (2013) 2236-44.https://www.ncbi.nlm.nih.gov/pubmed/23712546
[30] T.P. Miller, S. Dahlberg, J.R. Cassady, D.J. Adelstein, C.M. Spier, T.M. Grogan, M. LeBlanc, S. Carlin, E. Chase, and R.I. Fisher, Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate- and high-grade non-Hodgkin's lymphoma. N Engl J Med 339 (1998) 21-6.https://www.ncbi.nlm.nih.gov/pubmed/9647875
[31] C.P. Hans, Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 103 (2004) 275-282
[32] B.D. Cheson, S.J. Horning, B. Coiffier, M.A. Shipp, R.I. Fisher, J.M. Connors, T.A. Lister, J. Vose, A. Grillo-López, A. Hagenbeek, F. Cabanillas, D. Klippensten, W. Hiddemann, R. Castellino, N.L. Harris, J.O. Armitage, W. Carter, R. Hoppe, and G.P. Canellos, Report of an International Workshop to Standardize Response Criteria for Non-Hodgkin's Lymphomas. Journal of Clinical Oncology 17 (1999) 1244-1244
[33] G.L. Chen, Y. Huang, W. Zhang, X. Pan, W.J. Feng, X.Y. Zhao, X.D. Zhu, W.H. Li, M. Huang, Z.Y. Chen, and W.J. Guo, Three-Tier Prognostic Index in Young Adults With Advanced Gastric Cancer. Front Oncol 11 (2021) 667655.https://www.ncbi.nlm.nih.gov/pubmed/34568007
[34] F. Franco Perez, J. Lavernia, D. Aguiar-Bujanda, J. Miramon, J. Guma, R. Alvarez, J. Gomez-Codina, F.G. Arroyo, M. Llanos, M. Marin, J. Alfaro, C. Quero, M. Delgado, E. Nogales, F. Menarguez, N. Martinez, M. Torrente, A. Royuela, D. Abreu, and M. Provencio, Primary Breast Lymphoma: Analysis of 55 Cases of the Spanish Lymphoma Oncology Group. Clin Lymphoma Myeloma Leuk 17 (2017) 186-191.https://www.ncbi.nlm.nih.gov/pubmed/27847267
[35] P. Radkani, D. Joshi, J.C. Paramo, and T.W. Mesko, Primary breast lymphoma: 30 years of experience with diagnosis and treatment at a single medical center. JAMA Surg 149 (2014) 91-3.https://www.ncbi.nlm.nih.gov/pubmed/24257833
[36] H.Y. Yhim, H.J. Kang, Y.H. Choi, S.J. Kim, W.S. Kim, Y.S. Chae, J.S. Kim, C.W. Choi, S.Y. Oh, H.S. Eom, J.A. Kim, J.H. Lee, J.H. Won, H. Shim, J.J. Lee, H.J. Sung, H.J. Kim, D.H. Lee, C. Suh, and J.Y. Kwak, Clinical outcomes and prognostic factors in patients with breast diffuse large B cell lymphoma; Consortium for Improving Survival of Lymphoma (CISL) study. BMC Cancer 10 (2010) 321.https://www.ncbi.nlm.nih.gov/pubmed/20569446
[37] Y. Jia, C. Sun, Z. Liu, W. Wang, and X. Zhou, Primary breast diffuse large B-cell lymphoma: a population-based study from 1975 to 2014. Oncotarget 9 (2018) 3956-3967.https://www.ncbi.nlm.nih.gov/pubmed/29423097
[38] S. Fukuhara, T. Watanabe, W. Munakata, M. Mori, D. Maruyama, S.W. Kim, Y. Kobayashi, H. Taniguchi, A.M. Maeshima, R. Tanosaki, Y. Matsuno, and K. Tobinai, Bulky disease has an impact on outcomes in primary diffuse large B-cell lymphoma of the breast: a retrospective analysis at a single institution. Eur J Haematol 87 (2011) 434-40.https://www.ncbi.nlm.nih.gov/pubmed/21740461
[39] G.L. Chen, L. Guo, S. Yang, and D.M. Ji, Cancer risk in tuberculosis patients in a high endemic area. BMC Cancer 21 (2021) 679.https://www.ncbi.nlm.nih.gov/pubmed/34107921
[40] G. Li, G.L. Chen, Y. Zhou, G.Q. Yao, S. Yang, and D.M. Ji, Increased Risk of Lymphoma in Men or the Elderly Infected with Tuberculosis. Mediterr J Hematol Infect Dis 13 (2021) e2021053.https://www.ncbi.nlm.nih.gov/pubmed/34527205
[41] G.L. Chen, Z.G. Xia, J. Jin, B.H. Yu, and J. Cao, Characterization of Artificial Pneumothorax-Unrelated Pyothorax-Associated Lymphoma. J Oncol 2021 (2021) 3869438.https://www.ncbi.nlm.nih.gov/pubmed/33564306
[42] C. Dendle, M. Gilbertson, T. Spelman, R.L. Stuart, T.M. Korman, K. Thursky, S. Opat, and Z. McQuilten, Infection is an Independent Predictor of Death in Diffuse Large B Cell Lymphoma. Sci Rep 7 (2017) 4395.https://www.ncbi.nlm.nih.gov/pubmed/28667319
[43] S. Lanini, A.C. Molloy, P.E. Fine, A.G. Prentice, G. Ippolito, and C.C. Kibbler, Risk of infection in patients with lymphoma receiving rituximab: systematic review and meta-analysis. BMC Med 9 (2011) 36.https://www.ncbi.nlm.nih.gov/pubmed/21481281
[44] T.A. Eyre, W. Wilson, A.A. Kirkwood, J. Wolf, C. Hildyard, H. Plaschkes, J. Griffith, P. Fields, A. Gunawan, R. Oliver, S. Booth, J. Kothari, C.P. Fox, N. Martinez-Calle, A. McMillan, M. Bishton, G.P. Collins, and C.S.R. Hatton, Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP. Blood Adv 5 (2021) 2229-2236.https://www.ncbi.nlm.nih.gov/pubmed/33890978
[45] X. Rong, H. Wang, J. Ma, S. Pan, H. Wang, S. Jing, Y. Su, L. Wang, and C. Zhao, Chronic hepatitis B virus infection is associated with a poorer prognosis in diffuse large B-cell lymphoma: a meta-analysis and systemic review. J Cancer 10 (2019) 3450-3458.https://www.ncbi.nlm.nih.gov/pubmed/31293649
[46] M.M. Al-Mansour, S.A. Alghamdi, M.A. Alsubaie, A.A. Alesa, and M.A. Khan, Negative effect of hepatitis in overall and progression-free survival among patients with diffuse large B-cell lymphoma. Infect Agent Cancer 13 (2018) 18.https://www.ncbi.nlm.nih.gov/pubmed/29977329
[47] H.H. Huang, F.Y. Hsiao, H.M. Chen, C.Y. Wang, and B.S. Ko, Antiviral prophylaxis for hepatitis B carriers improves the prognosis of diffuse large B-cell lymphoma in Taiwan - a population-based study. Br J Haematol 192 (2021) 110-118.https://www.ncbi.nlm.nih.gov/pubmed/33131074
[48] R.N. Miranda, T.N. Aladily, H.M. Prince, R. Kanagal-Shamanna, D. de Jong, L.E. Fayad, M.B. Amin, N. Haideri, G. Bhagat, G.S. Brooks, D.A. Shifrin, D.P. O'Malley, C.Y. Cheah, C.E. Bacchi, G. Gualco, S. Li, J.A. Keech, Jr., E.P. Hochberg, M.J. Carty, S.E. Hanson, E. Mustafa, S. Sanchez, J.T. Manning, Jr., Z.Y. Xu-Monette, A.R. Miranda, P. Fox, R.L. Bassett, J.J. Castillo, B.E. Beltran, J.P. de Boer, Z. Chakhachiro, D. Ye, D. Clark, K.H. Young, and L.J. Medeiros, Breast implant-associated anaplastic large-cell lymphoma: long-term follow-up of 60 patients. J Clin Oncol 32 (2014) 114-20.https://www.ncbi.nlm.nih.gov/pubmed/24323027
[49] P.P. Liu, K.F. Wang, J.T. Jin, X.W. Bi, P. Sun, Y. Wang, H. Yang, Z.M. Li, W.Q. Jiang, and Y. Xia, Role of radiation therapy in primary breast diffuse large B-cell lymphoma in the Rituximab era: a SEER database analysis. Cancer Med 7 (2018) 1845-1851.https://www.ncbi.nlm.nih.gov/pubmed/29624913
[50] W. Haque, B. Dabaja, A. Tann, M. Khan, S. Szeja, E.B. Butler, and B.S. Teh, Changes in treatment patterns and impact of radiotherapy for early stage diffuse large B cell lymphoma after Rituximab: A population-based analysis. Radiother Oncol 120 (2016) 150-5.https://www.ncbi.nlm.nih.gov/pubmed/27373911
[51] N. Zhang, C. Cao, Y. Zhu, P. Liu, L. Liu, K. Lu, J. Luo, and N. Zhou, Primary breast diffuse large B-cell lymphoma in the era of rituximab. Onco Targets Ther 9 (2016) 6093-6097.https://www.ncbi.nlm.nih.gov/pubmed/27785056
[52] S. Yoshida, N. Nakamura, Y. Sasaki, S. Yoshida, M. Yasuda, H. Sagara, T. Ohtake, S. Takenoshita, and M. Abe, Primary breast diffuse large B-cell lymphoma shows a non-germinal center B-cell phenotype. Mod Pathol 18 (2005) 398-405.https://www.ncbi.nlm.nih.gov/pubmed/15492762
[53] A. Aviles, N. Neri, and M.J. Nambo, The role of genotype in 104 cases of diffuse large B-cell lymphoma primary of breast. Am J Clin Oncol 35 (2012) 126-9.https://www.ncbi.nlm.nih.gov/pubmed/21325938
[54] H. Nyman, E. Jantunen, E. Juvonen, E. Elonen, J. Bohm, V.M. Kosma, G. Enblad, M.L. Karjalainen-Lindsberg, and S. Leppa, Impact of germinal center and non-germinal center phenotypes on overall and failure-free survival after high-dose chemotherapy and auto-SCT in primary diffuse large B-cell lymphoma. Bone Marrow Transplant 42 (2008) 93-8.https://www.ncbi.nlm.nih.gov/pubmed/18391989
[55] N. Patil, and M. Girgis, Outcome of germinal center B-cell type compared to non-germinal center/activated B-cell type diffuse large b-cell lymphoma as determined by immunohistochemistry using the Hans algorithm. Journal of Clinical Oncology 38 (2020) e20076-e20076
[56] F. Franco, J. Gonzalez-Rincon, J. Lavernia, J.F. Garcia, P. Martin, C. Bellas, M.A. Piris, L. Pedrosa, J. Miramon, J. Gomez-Codina, D. Rodriguez-Abreu, I. Machado, C. Illueca, J. Alfaro, M. Provencio, and M. Sanchez-Beato, Mutational profile of primary breast diffuse large B-cell lymphoma. Oncotarget 8 (2017) 102888-102897.https://www.ncbi.nlm.nih.gov/pubmed/29262531
[57] X.X. Cao, J. Li, H. Cai, W. Zhang, M.H. Duan, and D.B. Zhou, Patients with primary breast and primary female genital tract diffuse large B cell lymphoma have a high frequency of MYD88 and CD79B mutations. Ann Hematol 96 (2017) 1867-1871.https://www.ncbi.nlm.nih.gov/pubmed/28803429
[58] S. Hu, Y. Song, X. Sun, L. Su, W. Zhang, J. Jia, O. Bai, S. Yang, R. Liang, X. Li, H. Zhang, Y. Gao, W. Zhang, X. Xiao, H. Bao, N. Wang, H. Ren, X. Cen, S. Yang, Y. Zhao, Y. Wang, Y. Wang, A. Liu, J. Wang, Y. Shi, M. Yuan, Y. Li, and X. He, Primary breast diffuse large B-cell lymphoma in the rituximab era: Therapeutic strategies and patterns of failure. Cancer Sci 109 (2018) 3943-3952.https://www.ncbi.nlm.nih.gov/pubmed/30302857
[59] T. Wen, J. Wang, Y. Shi, H. Qian, and P. Liu, Inhibitors targeting Bruton’s tyrosine kinase in cancers: drug development advances. Leukemia 35 (2020) 312-332