Overview: A group of malignant lymphomas of T-cell origin.
A group of malignant lymphomas derived from T-cells, different types have different clinical manifestations and molecular features, mainly manifested as localized lymph node enlargement and systemic B symptoms, the cause of the disease is still unclear, mainly associated with gene mutation, long-term inflammatory stimulation, etc. Different types of treatment options vary, mainly chemotherapy, surgery, targeted therapy, radiotherapy, etc.
Definition
Anaplastic large cell lymphoma (ALCL) is a malignant lymphoma of T-cell origin that is heterogeneous and aggressive.
Clinical manifestations of ALCL vary among different subtypes and include mainly localized lymph node enlargement and systemic B symptoms of lymphoma, i.e., fever, night sweats, and weight loss.
The hallmark cells of the tumor are large cells with horseshoe or renal-type nuclei, mostly expressing CD30 antigen, and common eosinophilic areas adjacent to the nucleus.
Staging or Classification
Based on clinical presentation and molecular features, ALCL is classified into the following four categories.
Primary systemic ALCL with mesenchymal lymphoma kinase (ALK) positivity (ALK-positive ALCL).
Primary systemic ALCL, ALK-negative (ALK-negative ALCL).
Breast implant-associated ALCL (BIA-ALCL).
Primary cutaneous-type ALCL (PC-ALCL).
Both ALK-positive ALCL and ALK-negative ALCL belong to the primary systemic type of ALCL.The main manifestations are rapidly progressive lymph node enlargement and systemic B symptoms. Peripheral lymph nodes are most frequently involved, followed by retroperitoneal lymph nodes.
BIA-ALCL occurs predominantly after breast implantation and presents with breast enlargement with seroma, breast lumps and enlarged lymph nodes.
PC-ALCL often presents as asymptomatic skin nodules or small lumps that may form ulcers on the surface.
Morbidity
ALCL accounts for approximately 1% to 2% of adult non-Hodgkin’s lymphomas (NHL) and 10% to 15% of pediatric lymphomas.
Primary systemic ALCL occurs in males, with a male/female ratio of approximately 1.5:1. More than 90% of pediatric and adolescent patients have ALK-positive ALCL, whereas only 40% to 50% of adult patients have ALK-positive ALCL.
Breast prosthesis-associated ALCL is highly prevalent 7 to 10 years after breast prosthesis implantation. It is clinically rare, with a prevalence of (23-33)/1 million.
Primary cutaneous ALCL is most common in the elderly, with a median age of onset of 60 years, and accounts for approximately 9% of cutaneous lymphomas. It is rare in children and adolescent population [1-5].
Etiology
Causes of the disease
The etiology of anaplastic large cell lymphoma (ALCL) is unclear and may be related to genetic mutations and long-term chronic inflammatory stimuli.
Mesenchymal lymphoma kinase (ALK)-positive ALCL mostly has t(2;5)/NPM-ALK translocation, and the pathogenic ALK fusion gene leads to activation of ALK kinase, which in turn leads to ALCL.
ALK-negative ALCL is mostly a t(6;7)(p25.3;q32.3) translocation involving the DUSP22 gene and the FRA7H fragile site.
Breast prosthesis-associated ALCL is most commonly seen in patients with hairy surface prosthesis implants, where chronic inflammatory stimulation leads to CD30-positive T-cell expansion. Mutations in genes such as JAK-STAK and TP53 have also been suggested to be associated with its occurrence.
The most common translocations in primary cutaneous ALCL are t(2;5)(p23;q35), forming the fusion gene protein NPM-ALK.
Risk factors or predisposing factors
People with a family history of lymphoma or a family history of hematologic malignancies.
High risk factors for breast prosthesis-associated ALCL are gross-surface prostheses and the probability of breast prosthesis-associated ALCL is greatest with prostheses that have a high degree of roughness and a large textured area.
Symptoms
Clinical symptoms vary somewhat from one anaplastic large cell lymphoma (ALCL) to another. They mainly include localized lymph node enlargement and systemic B symptoms.
Primary systemic ALCL
Includes anaplastic lymphoma kinase (ALK)-positive ALCL and ALK-negative ALCL.There is no significant difference in clinical presentation between the two, and about 2/3 of patients are diagnosed at stage III-IV, often with extra-lymph node invasion.
Systemic B symptoms
Unexplained fever, nocturnal night sweats and weight loss (10% weight loss within 6 months).
Lymph node invasion
About 90% of patients have enlarged lymph nodes, with peripheral lymph nodes most commonly involved, followed by retroperitoneal and mediastinal lymph nodes.
Involved lymph nodes may be painlessly enlarged or accompanied by redness, swelling and heat.
Extra-lymph node invasion
The main extra-lymph node tissues or organs involved are skin, soft tissue, bone and lungs.
Skin and soft tissues are most commonly involved, mainly in the form of multiple or single tumor foci, such as subcutaneous nodules and large ulcers.
Bone involvement is also common and may manifest as osteolytic bone damage, osteomas, etc.
Lung lesions may be nodular or infiltrative with or without malignant exudates.
Other tissues or organs outside the lymph nodes involved are bone marrow and central nervous system.
Breast implant-associated ALCL (BIA-ALCL)
It is highly prevalent 7 to 10 years after breast prosthesis implantation and often presents with breast enlargement with seroma, breast lumps and enlarged lymph nodes. Axillary lymph node involvement is most common.
Liver, small bowel, central nervous system and bone involvement have been reported.
Primary cutaneous ALCL (PC-ALCL)
It mainly presents as asymptomatic isolated nodules or small lumps on the skin, on the surface of which ulcers may form. It most commonly involves the trunk, extremities, face, and buttocks.
Only about 10% of skin lesions extend beyond one anatomic site. There may be enlargement of lymph nodes localized to the lesion.
Recurrent episodes are possible. The more extensive the skin damage, the higher the risk of developing extracutaneous lesions, and about 25% of patients eventually develop systemic disease.
In some cases, the skin lesions may resolve spontaneously.
Complications
Hypercytokinemia
Most commonly seen in ALK-positive ALCL. patients may develop hyperthermia and/or hypersensitivity. It may even lead to inflammatory factor storm and hemophagocytic syndrome. Manifestations include thrombocytopenia of whole blood cells, organ dysfunction, etc.
Acute tumor lysis syndrome
Not common in ALCL patients. When a large number of tumor cells are lysed, potassium, phosphate and uric acid are released into the blood circulation, causing a group of clinical syndromes mainly manifested by hyperuricemia, hyperkalemia, hyperphosphate, hypocalcemia and acute renal failure.
In patients with large tumor loads, hydration and allopurinol may be given to prevent tumor lysis syndrome.
Impairment of other organ function
When extra-lymph node organ involvement occurs, different degrees of organ function impairment may occur with disease progression and tumor infiltration.
The chance of occurrence is not high and the degree is mostly not serious [3-8].
Medical treatment
Department of Medicine
Hematology/Lymphoma
When there is unexplained fever, night sweats, weight loss, or enlarged lymph nodes, or when there is a pathologically confirmed diagnosis of interstitial large cell lymphoma, it is recommended to consult the hematology or lymphoma department.
Breast Surgery / Nail and Breast Surgery / General Surgery
After breast implant surgery, if there is fluid accumulation around the implant, breast swelling with or without pain, or axillary lymph node enlargement, it is recommended to consult Breast Surgery, Nail and Breast Surgery or General Surgery.
Dermatology
When a brown or purplish-blue tumor or lump appears on any part of the body, with different degrees of skin damage or ulcers on the surface, you should consult a dermatologist.
Preparation
Preparing for your visit: registering, preparing your documents, FAQs
Tips for your doctor’s visit
The doctor will usually conduct a physical examination. It is recommended that you choose loose-fitting clothes to complete the examination.
Changes in the enlarged lymph nodes can be recorded, and photos can be taken of any abnormalities in the skin.
Preparation Checklist
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Is there any unexplained fever, night sweats, weight loss?
Is there any unexplained swelling of lymph nodes?
Are there any skin abnormalities?
Medical history list
Is there a family history of lymphoma or other malignant tumors?
Any history of drug or food allergy?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Specialized tests: blood smear, bone marrow image test.
Imaging tests: ultrasound, CT, magnetic resonance imaging (MRI) and other imaging tests.
Laboratory tests: blood routine, urine routine, biochemical routine, etc.
Medication list
Medication used in the last 3 months, if available, bring the box or package to the doctor’s appointment
Medication history of Vincristine, Cyclophosphamide, Vibutuximab, etc.
Diagnosis
Diagnosis is based on
The diagnosis of anaplastic large cell lymphoma (ALCL) is based on clinical presentation, pathologic examination, immunohistochemical and molecular genetic findings, and imaging studies.
Primary systemic ALCL
Includes anaplastic lymphoma kinase (ALK)-positive ALCL and ALK-negative ALCL.
Clinical manifestations
Both are similar, with the main systemic B symptoms of lymphoma (unexplained fever, night sweats, and weight loss) and progressive lymph node enlargement.
Peripheral lymph nodes are most often involved. There is often extra-lymph node invasion of skin and soft tissues, bone, and lungs.
Laboratory and Pathologic Tests
Blood, urine, and biochemical routines are performed to understand the general status of the organism. Some patients may show elevated white blood cells, platelets, and C-reactive protein.
Bone marrow examination includes bone marrow biopsy and immunohistochemical examination, which has a higher positive rate than bone marrow aspiration.
Flow cytology examination can observe the morphology of tumor cells as well as antigen expression. It helps to identify other hematologic malignancies.
ALK-positive ALCL and ALK-negative ALCL mainly have different immunohistochemical and molecular genetic features.
ALK-positive ALCL: Immunohistochemistry is ALK-positive, with positive reactions localized to the nucleus and cytoplasm, and in a few cases to the cell membrane. In addition, CD3-/+, CD2+/-, CD5+/-, CD4+/-, CD25+, EMA+, TIA1+/-, CD15-, LMP1-. Genetically, t(2;5)(p23;q35) translocation was present in 84% of patients and t(1;2)(q25;p23) translocation in 13%.
ALK-negative ALCL: Immunohistochemistry was ALK-negative, in addition to CD3+, CD2+, CD5+, CD4+/-, CD8-/+, CD43+, EMA-/+, TIA1+/-. Genetically, 30% of patients had a t(6;7)(p25.3;q32.3) translocation.
Imaging
Whole-body imaging can clarify the site of involvement and stage the lymphoma.
Bone scanning is also feasible in patients with bone involvement, and cranial MRI or CT is feasible in central nervous system involvement.
PET-CT can help with disease staging, as well as re-evaluation.
Breast implant-associated ALCL (BIA-ALCL)
History
High incidence 7 to 10 years after breast implantation with a median age at diagnosis of 55 years.
Most commonly seen after hairy surface implant placement.
Clinical manifestations
Often presents with breast enlargement with seroma, breast lumps and enlarged lymph nodes. Axillary lymph node involvement is most common. Involvement of the liver, small bowel, central nervous system and bones is rare.
With or without systemic B symptoms.
Imaging
Breast ultrasound and MRI are commonly performed. Breast ultrasound can provide image guidance for fine needle aspiration. In the presence of a breast lump, MRI is more advantageous for differential diagnosis.
Laboratory and Pathologic Tests
If a breast lump or enlarged lymph node is found, a biopsy should be taken. If no lump is found, pathologic examination of the prosthetic envelope or periprosthetic fluid is feasible. The volume of fluid taken is preferably 50 ml.
Pathological examination reveals characteristic tumor cells with horseshoe or renal nuclei, eosinophilia, ALK-negative, strong expression of CD30 and often CD4.
Primary cutaneous ALCL (PC-ALCL)
Clinical manifestations
Mostly seen in the elderly.
The main manifestation is asymptomatic isolated skin nodules or small lumps, and ulcers may form on the surface. Only about 10% of skin lesions extend beyond one anatomic site. There may be enlargement of lymph nodes localized to the lesion.
Recurrent episodes may occur. The more extensive the skin lesions, the higher the risk of developing extracutaneous lesions, and about 25% of patients eventually develop systemic disease. In some cases, the skin lesions may resolve spontaneously.
Laboratory and Pathologic Examination
Excisional biopsy is preferred to excisional biopsy. Microscopically, the main manifestation is large, CD30-positive tumor cells adhering in sheets. There is often a large number of inflammatory cells infiltration. Mostly positive for CD30 and CD4, but negative for anaplastic lymphoma kinase (ALK).
Not all patients require a bone marrow examination. However, a bone marrow examination should be performed in cases of multifocal lesions, unexplained hematopenia, or definite extracutaneous involvement.
Imaging
CT or PET-CT is mainly used to assess the presence of systemic disease for disease staging [3-8].
Staging
Clinical staging of lymphoma is based on the site of disease invasion and the presence of B symptoms. Currently, the Ann Arbor (Cotswolds Revision) staging system is mainly used, and patients are also divided into group A and group B according to their systemic symptoms.
Group A: no systemic symptoms.
Group B: with systemic symptoms, including unexplained fever (temperature greater than 38°C for 3 or more consecutive days), night sweats (for 7 or more consecutive days), or weight loss (more than 10% within 6 months).
Ann Arbor-Cotswolds staging of lymphoma
Stage I invades one lymph node
Stage I invasion of one lymph node area (I), or invasion of a single extra-lymph node organ or site (IE)
Stage I
Invasion of one lymph node area (I), or invasion of a single extra-lymph node organ or site (IE)
Stage II on one side of the diaphragm with invasion of two or more lymph node areas (II) or plus limited invasion of a single extra-nodal organ or site (IIE)
Stage II
On one side of the diaphragm with invasion of two or more lymph node areas (II) or with additional limited invasion of an extranodal organ or site (IIE).
Stage III with invasion of lymph node areas on both sides of the diaphragm (III) or plus limited invasion of one extranodal organ or site (IIIE) or the spleen (IIIS) or both (IIIES)
Stage III
Invasion of lymph node areas on both sides of the diaphragm (III) or plus limited invasion of an extra-nodal organ or site (IIIE) or the spleen (IIIS) or both (IIIES)
Stage IV Diffuse or disseminated invasion of one or more extranodal organs with or without lymph node invasion
Stage IV
Diffuse or disseminated invasion of one or more extranodal organs with or without lymph node invasion
E: Lymphoma involving extranodal organs, involvement of a single extranodal site, and invasion of organs/tissues directly connected to lymph nodes/lymphoid tissue are not recorded as stage IV. Record the letter E after each stage.
X: Large tumor mass, tumor diameter > 1/3 of the width of the thorax or fusion mass with a maximum diameter > 10 cm [1].
Differential diagnosis
Differentiation of different subtypes of ALCL
The diagnosis of ALCL begins with the clarification of the subtypes, i.e., primary systemic ALCL, breast implant-associated ALCL (BIA-ALCL), and primary cutaneous ALCL (PC-ALCL). This is especially true when BIA-ALCL and PC-ALCL involve other tissues or organs with systemic manifestations.
BIA-ALCL is relatively simple to identify because of the presence of a well-defined breast implant and the clinical manifestations are mainly confined to the periampullary area.
When PC-ALCL involves other tissues or organs and presents with enlarged lymph nodes and systemic B symptoms, it may have the same clinical manifestations as primary systemic ALCL. When skin lesions suggestive of PC-ALCL are found to be ALK positive, primary systemic ALCL involvement of the skin is highly suspected.
The diagnosis of primary systemic ALCL also requires clarification as ALK-positive ALCL or ALK-negative ALCL.
ALK-positive ALCL: Most common in children or adolescents. Tumor cells have ALK expression.
ALK-negative ALCL: Mostly seen in adults aged 40-65 years. Tumor cells are ALK negative.
Differentiation of different subtypes of ALCL from other diseases
Primary systemic ALCL needs to be differentiated from diffuse large B-cell lymphoma (DLBCL)
Similarities: both present with progressive lymph node enlargement and systemic B symptoms. There is often involvement of organs or tissues outside the lymph nodes.
Differences: primary systemic ALCL is derived from T cells, and the hallmark cells of the tumor are large cells with horseshoe or renal-type nuclei, mostly expressing CD30 antigens. dLBCL is derived from mature B cells and expresses pan-B-cellular antigens, such as CD19, CD20, CD22, and CD45.
BIA-ALCL needs to be differentiated from infectious diseases or breast cancer.
Similarities: both may present with breast enlargement, lymph node enlargement, fever, etc.
Differences: Imaging assists in diagnosis and pathologic examination clarifies the diagnosis. Infectious diseases often have obvious changes in blood picture such as elevated white blood cells, and there are no proliferating CD30-positive tumor cells in pathology. Pathology of breast cancer shows tumor originating from the mammary epithelium.
PC-ALCL needs to be differentiated from lymphomatoid papulosis (LyP)
Similarities: PC-ALCL and LyP are both primary cutaneous CD30-positive T-cell lymphoproliferative disorders. Papulosquamous skin manifestations may be present.
Differences: LyP is a recurrent, self-healing disease. Compared to PC-ALCL, the skin lesions in LyP are usually small (<2 cm) and may resolve spontaneously after weeks to months.
Treatment
Treatment for different types of anaplastic large cell lymphoma (ALCL) varies, and the clinical decision should be based on the type, stage, and general status of the patient.
For primary systemic ALCL, chemotherapy is the mainstay. Currently there is a lack of uniform standardized protocols at home and abroad.
Breast implant-associated ALCL (BIA-ALCL) and primary cutaneous-type ALCL (PC-ALCL) are mostly treated with local surgery.
Treatment of primary systemic ALCL
Chemotherapy
Adult patients are mostly treated with CHOP regimen with or without etoposide.CHOP regimen is a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone.
Children’s chemotherapy regimens mostly refer to the chemotherapy regimen of ALCL99, and it should be noted that anthracyclines and alkylating agents should be selected with less long-term side effects. They mainly include dexamethasone, cyclophosphamide, and vincristine.
Targeted therapy
Vibutuximab is an antibody-coupled drug (ADC) targeting CD30, which has specific killing effect on tumor cells expressing CD30. Vibutuximab has been approved in China for the treatment of adult patients with relapsed or refractory systemic ALCL, and primary cutaneous ALCL who have received prior systemic therapy.
Mesenchymal lymphoma kinase (ALK) inhibitors, such as crizotinib, have also shown reliable efficacy in ALK-positive ALCL. They are now mostly used for the treatment of relapsed or refractory ALK-positive ALCL.
Hematopoietic stem cell transplantation
Including autologous hematopoietic stem cell transplantation and allogeneic hematopoietic stem cell transplantation.
It is mainly used for the treatment of relapsed or refractory patients, and hematopoietic stem cell transplantation has also been reported in some patients after the first remission.
Whether or not HSCT is suitable, when to choose HSCT, and what type of HSCT to choose need to be comprehensively evaluated by clinicians based on the patient’s age, ALK status, and predicted prognosis.
Others
Radiation therapy is only indicated for patients with primary systemic ALCL who have limited lesions and cannot tolerate chemotherapy. There are also exploratory applications of PDGFRB, JAK-STAT, mTOR, and PI3K inhibitors, immune checkpoint inhibitors, and anti-ALK vaccines in the treatment of primary systemic ALCL.
Treatment of breast implant-associated ALCL (BIA-ALCL)
Surgical treatment
Multidisciplinary discussion among plastic surgeons, hematology/breast oncology specialists, pathologists, and imaging physicians is required before surgery to clarify the diagnosis and develop a treatment plan.
Surgical treatment requires complete removal of the prosthesis, the envelope and any associated mass.
The prosthetic envelope can drain to multiple regional lymph nodes, making biopsy of the anterior lymph nodes of little significance. If clinical examination or imaging reveals enlarged axillary lymph nodes, excisional biopsy should be used.
Systemic treatment
It is mainly used in patients with unresectable chest wall infiltrating lesions, disseminated lesions or recurrent lesions.
Refer to the systemic treatment regimen for patients with primary systemic ALCL, including chemotherapy with the CHOP regimen and targeted therapy with vibutuximab.
Primary cutaneous ALCL (PC-ALCL)
Surgical treatment and/or radiotherapy
Primarily used for the treatment of isolated lesions, which can be treated by complete surgical excision or radiotherapy. Surgical treatment needs to ensure negative margins.
If pathology confirms isolated localized lymph node involvement, radiotherapy to the primary lesion and involved lymph nodes is required.
Usually, with surgical treatment and/or radiotherapy, most patients with limited lesions achieve complete remission, but most patients relapse. When the recurrence is still a limited lesion, surgical treatment and/or radiotherapy is still an option.
Systemic treatment
Systemic therapy needs to be considered for patients who have multiple recurrences, whose health is jeopardized by further surgical treatment and/or radiotherapy, or who have non-confined lesions.
Monotherapy, including oral methotrexate or vilbutuximab, is the treatment of choice.
Multi-agent chemotherapy such as the CHOP regimen is used only in PC-ALCL patients with extensive lymph node or visceral involvement [3,5-10].
Prognosis
Cure.
The prognosis of anaplastic large cell lymphoma (ALCL) is related to factors such as staging, tissues or organs involved, and age of the patient.
Primary systemic ALCL is aggressive, in which the prognosis of mesenchymal lymphoma kinase (ALK)-positive ALCL is superior to that of ALK-negative ALCL, but this advantage is only seen in pediatric and young adult patients.
Breast implant-associated ALCL (BIA-ALCL) generally presents as inert, and if the lesion does not encroach beyond the implant envelope, complete surgical excision tends to result in a favorable prognosis.
Primary cutaneous ALCL (PC-ALCL) has a mostly favorable prognosis, with a 10-year survival rate of 90%.
Prognostic factors
Advanced age, increased β-2 microglobulin (≥3 mg/L), ALK-negativity, and TP63 gene rearrangement are considered poor prognostic factors for primary systemic ALCL. The International Prognostic Index (IPI) score is an independent prognostic factor for ALCL. According to the score, it can be categorized into low-risk group (0-1), low-intermediate-risk group (2-3), high-intermediate-risk group (4-5), and high-risk group (≥6), and the higher the score, the worse the prognosis.
Poor prognostic factors for BIA-ALCL were mass, extraperitoneal invasion, and bilateral lesions.
PC-ALCL leg involvement portends a poorer prognosis [4-5,9].
National Comprehensive Cancer Network (NCCN) risk factors and scores for IPI
Risk factor score (points)
Age >40 years and ≤60 years >60 years and ≤75 years >75 years 123
Age >40 years and ≤60 years >60 years and ≤75 years >75 years
123
Lactate dehydrogenase level >1 times the normal value and ≤3 times the normal value >1 times the normal value 12
Lactate dehydrogenase level >1 times the normal value and ≤3 times the normal value >1 times the normal value
12
Ann Arbor stage: III or IV1
Ann Arbor staging: Stage III or IV
1
Extranodal involvement (including bone marrow, central nervous system, liver, gastrointestinal tract or lungs) 1
Extranodal involvement (including bone marrow, central nervous system, liver, gastrointestinal tract, or lungs)
1
ECOG ≥2 points 1
ECOG ≥2 points
1
Daily
Daily management
Dietary management
Pay attention to a balanced dietary structure with diversified and abundant food types. Eat more vitamin-rich vegetables and fruits, such as tomatoes, celery, lettuce, kiwi, apples and bananas. Eat more protein-rich foods, such as eggs, milk, lean meat and fish.
Avoid eating pickled, fried and deep-fried foods. It is recommended not to eat foods that stimulate the secretion of gastric acid, such as overly sweet and spicy foods.
Anorexia, nausea and vomiting may occur during chemotherapy. You may eat small meals and eat easy-to-digest, light food. If necessary, consult your doctor if you need to take anti-emetic drugs.
Life management
Patients with primary cutaneous ALCL with skin lesions are advised to wear loose-fitting, cotton clothing. Do not use skin care products freely.
Adopt regular living and resting habits, and keep the living environment clean, with adequate ventilation and appropriate temperature and humidity.
Ensure adequate sleep and rest. When your condition improves, you should take appropriate physical exercise under the guidance of your doctor.
During chemotherapy or radiotherapy, there may be a decrease in white blood cells, which may increase the risk of infection. Good hygiene should be maintained and rooms should be sterilized regularly. Pay attention to keep warm, avoid catching cold and reduce close contact with people to reduce the risk of infection.
During chemotherapy or radiotherapy, conditions such as thrombocytopenia may occur. Pay attention to avoid accidental bumps and other injuries to the body. If unexplained subcutaneous bruising or bruising occurs, consult your doctor if symptomatic treatment is needed.
Hair loss may occur with chemotherapy, and the hair will grow back after the treatment is finished, so do not worry too much.
Radiotherapy may cause dry, itchy skin. Avoid strong heat or cold stimulation of the skin at the radiotherapy site and avoid direct sunlight. Do not peel the skin with your hands when molting and crusting occurs. When cleaning the skin at the radiotherapy site, use a soft towel, be gentle, and avoid using harsh soaps.
When weakness and dizziness occur, you need to check for anemia, which can be relieved by strengthening nutrition. If necessary, ask your doctor if you need to take medication to correct the anemia.
Psychological support
After diagnosis or during treatment, the patient may develop a sense of fear or resistance. Family members should pay attention to listen to the patient’s heart, communicate with the patient to relieve anxiety, so that the patient can face the treatment positively with a good attitude.
Breast implant-related ALCL patients may have bilateral breast asymmetry after surgery, etc. Listen to the patient’s needs and consult the doctor for follow-up treatment recommendations. Particular attention needs to be paid to patients whose reason for breast prosthesis implantation surgery is breast cancer, and the psychological stress caused by another tumor diagnosis is more pronounced.
Patients with primary cutaneous ALCL may have skin scarring and are encouraged to relax and be positive. Consult the physician for follow-up treatment options.