Allogeneic hematopoietic stem cell transplant following chemotherapy containingl-asparaginase as a promising treatment for patients with relapsed or refractory extranodal natural killer/T cell lymphoma, nasal type

Abstract

The prognosis of advanced extranodal NK/T cell lymphoma (ENKTL) is poor. Allogeneic hematopoietic stem cell transplant (allo-HSCT) has been suggested to be a promising treatment for this disease, but its utility has yet to be established. Here we retrospectively analyzed five cases of ENKTL treated with allo-HSCT in our institute. After induction chemotherapy, disease status at allo-HSCT was second CR in three patients and refractory in two patients. All patients received a myeloablative conditioning regimen, and GVHD prophylaxis consisted of tacrolimus or cyclosporine with short-term methotrexate. Only one patient who received conventional induction chemotherapy developed severe complications, which needed long-term treatment, while others who received chemotherapy containing l-asparaginase did not have severe complications. There were no cases of treatment-related mortality, and all patients survived without disease for a median follow-up period of 1911 days. These results suggested that allo-HSCT following l-asparaginase-containing induction chemotherapy might improve the outcome of advanced ENKTL.

Allogeneic haematopoietic SCT for natural killer/T-cell lymphoma: a multicentre analysis from the Asia Lymphoma Study Group

“…Two studies were conducted before L-asparaginse-containing regimens were used, 11,14 whereas two studies contained some patients treated with L-asparaginase-containing regimens. 12,13 Owing to the heterogeneity and small numbers of patients involved, most studies only stressed the feasibility of allogeneic HSCT.…”

“…6,10 Owing to a putative graft-versus-lymphoma effect, allogeneic HSCT has also been explored, especially in poor-risk patients with advanced-stage disease. [11][12][13] In an earlier study of allogeneic HSCT in 28 patients with CD56-positive neoplasms, which included 22 patients with NK/T-cell lymphoma, the 2-year OS and PFS were 40% and 34%, with a TRM of 20-30% depending on the conditioning regimen. 11 Unfortunately, results of patients with NK/T-cell lymphomas were not separately described, and the survivals were not spectacular in comparison with L-asparaginasecontaining regimens.…”

Current and future management of NK/T-cell lymphoma based on clinical trials

“…Several retrospective analyses have shown that some patients who underwent HSCT obtained a long-term CR [58,59], suggesting HSCT may be a cure-oriented therapy for disseminated ENKL, although these data were obtained before 'the SMILE era'. Recently, there have been accumulating data on the promising efficacy of allogeneic HSCT for relapsed or refractory ENKL [60,61], and experts in East Asia recommend allogeneic HSCT for this population [49,62].…”

Extranodal NK/T-cell lymphoma: a review of literature and case report

“…В 2015 г. были опубликованы данные корейского проспективного исследования, где продемонстрированы более высокие показатели ОВ и БПВ больных, получивших после индукционной SMILE-терапии высокодозную консо-лидацию с последующей аутотрансплантацией гемо-поэтических клеток [46]. По данным зарубежных ис-точников литературы, трансплантация аллогенного костного мозга (аллоТКМ) не является до конца из-ученным методом лечения ЭНКТЛ и применяется в основном для консолидации ремиссии при рецидив-ных и рефрактерных формах заболевания [47]. Тем не менее у части больных с неблагоприятным прогнозом заболевания удается достичь длительной полной ре-миссии после выполнения аллоТКМ [48].…”