Extranodal natural killer/T-cell lymphoma from skin or soft tissue: suggestion of treatment from multinational retrospective analysis

Ahn, Hee Kyung; Suh, Cheolwon; Chuang, Shih Sung; Suzumiya, Junji; Ko, Young Hyeh; Kim, S. J.; Huh, Jooryung; Yoon, Dok Hyun; Oh, Sung Yong; Kim, Jin Seok; Lee, S. I.; Park, K. W.; Hsieh, Pin‐Pen; Nakamura, Shota; Yoshino, Tadashi; Ito, Kei; Nagatani, Tetsuya; Oshimi, Kazuo; Suzuki, Ritsuro; Kim, W. S.

doi:10.1093/annonc/mds096

Cited by 44 publications

(48 citation statements)

References 21 publications

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“…Similar significant differences in OS and PFS between RT and CT alone were also observed in the adjusted population. These results are consistent with other studies that compared survival across different treatments in earlystage NKTCL, 1,3,7,[18][19][20][21]30,33 with reported 5-year OS rates ranging from 50% to 90% after RT vs ,30% for CT alone. The striking difference in 5-year OS (.20%) between RT and CT alone suggests RT is an essential treatment of early-stage NKTCL and that CT alone should not be routinely administrated.…”

Section: Blood 17 September 2015 X Volume 126 Number 12 Risk-adaptesupporting

confidence: 91%

“…The outcomes for CT alone in early-stage NKTCL have been poor (CR, 20%-50%; overall response rate, 50%-70%; 5-year OS, 10%-35%, and even poorer PFS). [1][2][3]18,19,[30][31][32][33] Similarly, we confirmed the unfavorable prognosis of early-stage patients treated with CT alone-regardless of regimens-and obtained a significant survival improvement after RT (in both multivariable and PSM analysis). In the unadjusted population, 5-year OS was only 33.9% for CT alone compared with 69.6% for RT alone and 67.7% for RT with or without CT.…”

Section: Blood 17 September 2015 X Volume 126 Number 12 Risk-adaptesupporting

confidence: 73%

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Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study

Yang

Zhu

Cao

et al. 2015

Blood

156

167

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Key Points• Patients with early-stage extranodal nasal-type NKTCL were classified as low risk or high risk using 5 independent prognostic factors.• Risk-adapted therapy of RT alone for the low-risk group and RT consolidated by CT for the high-risk group proved the most effective treatment.The optimal combination and sequence of radiotherapy (RT) and chemotherapy (CT) for extranodal nasal-type natural killer/T-cell lymphoma (NKTCL) are not well-defined. The aim of this study was to create a risk-adapted therapeutic strategy for early-stage NKTCL.A total of 1273 early-stage patients from 10 institutions were reviewed. Patients received CT alone (n 5 170), RT alone (n 5 253), RT followed by CT (n 5 209), or CT followed by RT (n 5 641). A comprehensive comparative study was performed using multivariable and propensity score-matched analyses. Early-stage NKTCL was classified as low risk or high risk based on 5 independent prognostic factors (stage, age, performance status, lactate dehydrogenase, primary tumor invasion). RT alone and RT with or without CT were more effective than CT alone (5-year overall survival [OS], 69.6% and 67.7% vs 33.9%, P < .001).For low-risk patients, RT alone achieved a favorable OS (88.8%); incorporation of induction or consolidation CT did not provide additional benefit (86.9% and 86.3%). For highrisk patients, RT followed by CT resulted in superior OS (72.2%) compared with induction CT and RT (58.3%, P 5 .004) or RT alone (59.6%, P 5 .017). After adjustment, similar significant differences in OS were still observed between treatment groups. New CT regimens provided limited benefit in early-stage NKTCL. Risk-adapted therapy involving RT alone for low-risk patients and RT consolidated by CT for high-risk patients is a viable, effective strategy for early-stage NKTCL. (Blood. 2015;126(12):1424-1432 Medscape Continuing Medical Education online This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see page 1517.

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Section: Blood 17 September 2015 X Volume 126 Number 12 Risk-adaptesupporting

confidence: 91%

Section: Blood 17 September 2015 X Volume 126 Number 12 Risk-adaptesupporting

confidence: 73%

Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study

Yang

Zhu

Cao

et al. 2015

Blood

156

167

View full text Add to dashboard Cite

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“…Radiotherapy with or without chemotherapy also resulted in better OS than chemotherapy. 65 In another retrospective study where PET/CT was used to exclude occult nasal primaries, 11 patients with nonnasal lymphomas treated with SMILE had an ORR of 72.7%, with CR achieved in 54.5%. 24 Current data indicate that localized nonnasal lymphomas might not fare as well as nasal lymphomas.…”

Section: Treatment Of Localized Disease Outside the Nasal Regionmentioning

confidence: 99%

How I treat NK/T-cell lymphomas

Tse

Kwong

2013

Blood

270

281

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Natural killer (NK)/T-cell lymphomas and NK-cell leukemias are aggressive malignancies. Occurring worldwide, they show a predilection for Asian and South American populations. Neoplastic cells are surface CD3−, cytoplasmic CD3ε+, CD56+, cytotoxic-molecule positive, Epstein-Barr virus (EBV) positive, with germline T-cell receptor gene. Lymphomas occur commonly in the nasal and upper aerodigestive region. Occasional cases present in the skin, salivary gland, testis, and gastrointestinal tract. Rare cases are disseminated with lymphadenopathy, hepatosplenomegaly, and a leukemic phase. Positron emission tomography computed tomography is useful in staging, as lymphomas are 18-fluorodeoxyglucose avid. Quantification of circulating EBV DNA is an accurate biomarker of tumor load. Nasal NK/T-cell lymphomas present mostly with stage I/II disease. Concomitant/sequential chemotherapy and radiotherapy is standard treatment. Radiotherapy alone is inadequate because of high systemic failure rate. For stage III/IV nasal, nonnasal, and disseminated lymphomas, systemic chemotherapy is indicated. Regimens containing l-asparaginase and drugs unaffected by P-glycoprotein are most effective. Hematopoietic stem cell transplantation (HSCT) is not indicated for early-stage nasal lymphomas. HSCT for lymphomas not in remission has poor results. In advanced-stage nasal, nonnasal, disseminated, or relapsed lymphomas, HSCT may be considered when remission is achieved. Prognostic modeling and EBV DNA monitoring may be useful in risk stratification for HSCT.

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“…Recent studies showed that for localized disease, concurrent chemoradiation and chemotherapy yielded a long-term survival of 70-80 % [8,9]. However, in cases with advanced stage disease or in extranasal cases, long-term survival beyond 1 year is extremely rare [1,4,[10][11][12]. Even high-dose chemotherapy and auto-hematopoietic stem cell transplantation cannot overcome the refractoriness [13].…”

Section: Introductionmentioning

confidence: 99%

Gemcitabine alone and/or containing chemotherapy is efficient in refractory or relapsed NK/T-cell lymphoma

et al. 2012

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Extranodal natural killer/T-cell lymphoma (ENKL) has a dismal prognosis. Although L-asparaginase has shown promising efficacy as a frontline therapy, currently there are no treatment options after progression to an L-asparaginase-containing regimen. We report the results of gemcitabine-containing therapy in patients with relapsed or refractory ENKL. We retrospectively reviewed 20 patients with refractory or relapsed ENKL who received a gemcitabine-containing regimen between 2005 and 2011. The overall response rate was 40% (8 of 20 patients) with a complete response (CR) rate of 20% (n = 4) and a partial response (PR) rate of 20% (n = 4). Four complete responders had a disease-free status for more than 7 months including two patients received autologous stem cell transplantation consolidation and L-aspraginase maintenance, respectively. The median progression-free survival of the 20 patients was 2.3 months; however, it was 7.3 months for eight responders (CR and PR). The median overall survival of the eight responders had not been reached at the time of analysis. Gemcitabine was effective in a subset of pretreated ENKL patients and can be considered as a salvage option.

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Extranodal natural killer/T-cell lymphoma from skin or soft tissue: suggestion of treatment from multinational retrospective analysis

Cited by 44 publications

References 21 publications

Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study

Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study

How I treat NK/T-cell lymphomas

Gemcitabine alone and/or containing chemotherapy is efficient in refractory or relapsed NK/T-cell lymphoma

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