151
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 and 6927=6927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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152
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 union all select null,null,null#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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153
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 union all select null,null#] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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154
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 union all select null,null,null,null,null,null,null,null,null,null-- auhc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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155
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 waitfor delay '0:0:5'-- ouze] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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156
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 union all select null,null,null,null,null,null-- obdc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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157
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 union all select null,null,null-- jmtv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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158
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2010. [DOI: 10.1093/annonc/mdp418 and 7169=convert(int,(select char(113)+char(120)+char(106)+char(107)+char(113)+(select (case when (7169=7169) then char(49) else char(48) end))+char(113)+char(112)+char(113)+char(98)+char(113)))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kohrt H, Advani R. Extranodal natural killer/T-cell lymphoma: current concepts in biology and treatment. Leuk Lymphoma 2010; 50:1773-84. [PMID: 19883307 DOI: 10.3109/10428190903186502] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Natural killer/T-cell (NK/T) lymphomas represent a group of rare tumors of NK and NK-T cells. The World Health Organization classifies NK-cell tumors into three types, extranodal NK/T-cell lymphomas (ENKL, nasal and non-nasal), NK-cell leukemias, and a blastic variant (CD4-positive, CD56-positive hematodermic neoplasms). We focus our review to the current concepts in biology and treatment of ENKL. Though considerable advances have been made in our understanding of NK-cell biology, malignant transformation including the role of Epstein-Barr virus, and prognosis, the rare nature of ENKL and its heterogeneity limit the ability to standardize therapy. Radiotherapy is fundamental to treatment of early-stage disease with a role for chemoradiotherapy among high-risk patients. The clinical course of advanced disease is highly aggressive with frequent chemotherapy resistance and a poor prognosis. Therapeutic approaches to advanced-stage or relapsed and refractory disease, including the appropriate sequence of chemotherapy, combined modality therapy, and stem cell transplantation is not well-established. International and multicenter clinical trials are needed for this rare and aggressive disease.
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Affiliation(s)
- Holbrook Kohrt
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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Kim SJ, Kim K, Kim BS, Kim CY, Suh C, Huh J, Lee SW, Kim JS, Cho J, Lee GW, Kang KM, Eom HS, Pyo HR, Ahn YC, Ko YH, Kim WS. Phase II Trial of Concurrent Radiation and Weekly Cisplatin Followed by VIPD Chemotherapy in Newly Diagnosed, Stage IE to IIE, Nasal, Extranodal NK/T-Cell Lymphoma: Consortium for Improving Survival of Lymphoma Study. J Clin Oncol 2009; 27:6027-32. [DOI: 10.1200/jco.2009.23.8592] [Citation(s) in RCA: 262] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose On the basis of the benefits of frontline radiation in early-stage, extranodal, natural killer (NK)/T-cell lymphoma (ENKTL), we conducted a phase II trial of concurrent chemoradiotherapy (CCRT) followed by three cycles of etoposide, ifosfamide, cisplatin, and dexamethasone (VIPD). Patients and Methods Thirty patients with newly diagnosed, stages IE to IIE, nasal ENKTL received CCRT (ie radiation 40 to 52.8 Gy and cisplatin 30 mg/m2 weekly). Three cycles of VIPD (etoposide 100 mg/m2 days 1 through 3, ifosfamide 1,200 mg/m2 days 1 through 3, cisplatin 33 mg/m2 days 1 through 3, and dexamethasone 40 mg days 1 through 4) were scheduled after CCRT. Results All patients completed CCRT, which resulted in 100% response that included 22 complete responses (CRs) and eight partial responses (PRs). The CR rate after CCRT was 73.3% (ie, 22 of 30 responses; 95% CI, 57.46 to 89.13). Twenty-six of 30 patients completed the planned three cycles of VIPD, whereas four patients did not because they withdrew (n = 2) or because they had an infection (n = 2). The overall response rate and the CR rate were 83.3% (ie; 25 of 30 responses; 95% CI, 65.28 to 94.36) and 80.0% (ie, 24 of 30 responses; 95% CI, 65.69 to 94.31), respectively. Only one patient experienced grade 3 toxicity during CCRT (nausea), whereas 12 of 29 patients experienced grade 4 neutropenia. The estimated 3-year, progression-free and overall survival rates were 85.19% (95% CI, 72.48 to 97.90) and 86.28% (95% CI, 73.97 to 98.59), respectively. Conclusion Patients with newly diagnosed, stages IE to IIE, nasal ENKTL are best treated with frontline CCRT.
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Affiliation(s)
- Seok Jin Kim
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Kihyun Kim
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Byung Soo Kim
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Chul Yong Kim
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Cheolwon Suh
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Jooryung Huh
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Sang-Wook Lee
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Jin Seok Kim
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Jaeho Cho
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Gyeong-Won Lee
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Ki Mun Kang
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Hyeon Seok Eom
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Hong Ryull Pyo
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Yong Chan Ahn
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Young Hyeh Ko
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
| | - Won Seog Kim
- From the Departments of Pathology and Radiation Oncology; and Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; Department of Radiation Oncology and Division of Oncology and Hematology, Department of Internal Medicine, Korea University Hospital, College of Medicine; Departments of Oncology, Pathology, and Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine; and Department of Radiation Oncology and
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Successful treatment of refractory advanced nasal NK/T cell lymphoma with unrelated cord blood stem cell transplantation incorporating focal irradiation. Int J Hematol 2009; 91:107-11. [DOI: 10.1007/s12185-009-0453-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/07/2009] [Accepted: 11/13/2009] [Indexed: 10/20/2022]
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162
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Kim TM, Heo DS. Extranodal NK / T-cell lymphoma, nasal type: new staging system and treatment strategies. Cancer Sci 2009; 100:2242-8. [PMID: 19758393 PMCID: PMC11159079 DOI: 10.1111/j.1349-7006.2009.01319.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Extranodal NK/T-cell lymphoma (NTCL) is characterized by clinical heterogeneity based on clinical prognostic factors and survival outcome. NTCL subsets are classified as upper aerodigestive tract (UAT) NTCL or non-UAT NTCL; non-UAT has pathologic similarity to UAT-NTCL but is a clinically distinct subtype. Due to the clinical heterogeneity of NTCL, optimal treatment modalities and prognostic factors have been difficult to determine. Ann Arbor staging for lymphomas and the International Prognostic Index (IPI) have been used to predict prognosis for UAT-NTCL; however, local tumor invasiveness (bony invasion or perforation or invasion of the overlying skin) is the most significant factor for poor outcomes in localized UAT-NTCL. Thus, a new staging system is proposed: limited disease (stage I/II UAT-NTCL without local tumor invasiveness) and extensive disease (stage I/II with local invasiveness or stage III/IV disease of UAT NTCL, and non-UAT NTCL) based on treatment outcomes. NTCL is resistant to anthracycline-based chemotherapy, whereas non-anthracycline combination chemotherapy (such as ifosfamide, methotrexate, etoposide, and prednisolone) has an activity against NTCL as either a front-line or as a second-line treatment. The effectiveness of radiotherapy is evident in limited disease, but questionable in extensive disease.
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Affiliation(s)
- Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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163
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Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Ohshima K, Matsuno Y, Terauchi T, Nawano S, Ishikura S, Kagami Y, Hotta T, Oshimi K. Phase I/II Study of Concurrent Chemoradiotherapy for Localized Nasal Natural Killer/T-Cell Lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol 2009; 27:5594-600. [DOI: 10.1200/jco.2009.23.8295] [Citation(s) in RCA: 269] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PurposeTo explore a more effective treatment for localized nasal natural killer (NK)/T-cell lymphoma, we conducted a phase I/II study of concurrent chemoradiotherapy.Patients and MethodsTreatments comprised concurrent radiotherapy (50 Gy) and 3 courses of dexamethasone, etoposide, ifosfamide, and carboplatin (DeVIC). Patients with a newly diagnosed stage IE or contiguous IIE disease with cervical node involvement and a performance status (PS) of 0 to 2 were eligible for enrollment. The primary end point of the phase II portion was a 2-year overall survival in patients treated with the recommended dose.ResultsOf the 33 patients enrolled, 10 patients were enrolled in the phase I portion and a two thirds dose of DeVIC was established as the recommended dose. Twenty-seven patients (range, 21 to 68; median, 56 years) treated with the recommended dose showed the following clinical features: male:female, 17:10; stage IE, 18; stage IIE, 9; B symptoms present, 10; elevated serum lactate dehydrogenase, 5; and PS 2, 2. With a median follow-up of 32 months, the 2-year overall survival was 78% (95% CI, 57% to 89%). This compared favorably with the historical control of radiotherapy alone (45%). Of the 26 patients assessable for a response, 20 (77%) achieved a complete response, with one partial response. The overall response rate was 81%. The most common grade 3 nonhematologic toxicity was mucositis related to radiation (30%). No treatment-related deaths were observed.ConclusionConcurrent chemoradiotherapy using multidrug resistance-nonrelated agents and etoposide is a safe and effective treatment for localized nasal NK/T-cell lymphoma and warrants further investigation.
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Affiliation(s)
- Motoko Yamaguchi
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Kensei Tobinai
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Masahiko Oguchi
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Naoki Ishizuka
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Yukio Kobayashi
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Yasushi Isobe
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Kenichi Ishizawa
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Nobuo Maseki
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Kuniaki Itoh
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Noriko Usui
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Izumi Wasada
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Tomohiro Kinoshita
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Koichi Ohshima
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Yoshihiro Matsuno
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Takashi Terauchi
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Shigeru Nawano
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Satoshi Ishikura
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Yoshikazu Kagami
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Tomomitsu Hotta
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
| | - Kazuo Oshimi
- From the Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu; Hematology and Stem Cell Transplantation Division and the Radiation Oncology Division, National Cancer Center Hospital; Department of Radiation Oncology, Japanese Foundation for Cancer Research Cancer Institute Hospital; Department of Community Health and Medicine, Research Institute International Medical Center of Japan; Department of Hematology, Juntendo University School of Medicine; Division of Hematology
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164
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Suzuki R, Suzumiya J, Yamaguchi M, Nakamura S, Kameoka J, Kojima H, Abe M, Kinoshita T, Yoshino T, Iwatsuki K, Kagami Y, Tsuzuki T, Kurokawa M, Ito K, Kawa K, Oshimi K. Prognostic factors for mature natural killer (NK) cell neoplasms: aggressive NK cell leukemia and extranodal NK cell lymphoma, nasal type. Ann Oncol 2009; 21:1032-40. [PMID: 19850638 DOI: 10.1093/annonc/mdp418] [Citation(s) in RCA: 189] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with natural killer (NK) cell neoplasms, aggressive NK cell leukemia (ANKL) and extranodal NK cell lymphoma, nasal type (ENKL), have poor outcome. Both diseases show a spectrum and the boundary of them remains unclear. The purpose of this study is to draw a prognostic model of total NK cell neoplasms. PATIENTS AND METHODS We retrospectively analyzed 172 patients (22 with ANKL and 150 with ENKL). The ENKLs consisted of 123 nasal and 27 extranasal (16 cutaneous, 9 hepatosplenic, 1 intestinal and 1 nodal) lymphomas. RESULTS Complete remission rate for ENKL was 73% in stage I, but 15% in stage IV, which was consistent with that for ANKL (18%). The prognosis of ENKL was better than that of ANKL (median survival 10 versus 1.9 months, P < 0.0001) but was comparable when restricted to stage IV cases (4.0 months, P = 0.16). Multivariate analysis showed that four factors (non-nasal type, stage, performance status and numbers of extranodal involvement) were significant prognostic factors. Using these four variables, an NK prognostic index was successfully constructed. Four-year overall survival of patients with zero, one, two and three or four adverse factors were 55%, 33%, 15% and 6%, respectively. CONCLUSION The current prognostic model successfully stratified patients with NK cell neoplasms with different outcomes.
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Affiliation(s)
- R Suzuki
- Department of HSCT Data Management, Nagoya University School of Medicine, Nagoya, Japan.
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165
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Kwong YL. High-dose chemotherapy and hematopoietic SCT in the management of natural killer-cell malignancies. Bone Marrow Transplant 2009; 44:709-14. [DOI: 10.1038/bmt.2009.239] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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166
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Treatment outcome of radiotherapy alone versus radiochemotherapy in early stage nasal natural killer/T-cell lymphoma. Med Oncol 2009; 27:798-806. [PMID: 19685292 DOI: 10.1007/s12032-009-9288-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 08/02/2009] [Indexed: 10/20/2022]
Abstract
This study aims to investigate the prognostic factors and long-term treatment outcome in patients with early stage nasal natural killer (NK)/T-cell lymphoma. Sixty-four patients were recruited in this study, whose clinical and laboratory data were collected from hospital records. Early stage (stage IE: 51, stage IIE: 13) nasal NK/T-cell lymphoma (NNTCL) was established according to Ann Arbor staging classification. Among these patients, 23 received radiotherapy (RT) alone, the remaining 41 cases were treated with radiochemotherapy (RCT) comprised of 1-6 cycles of anthracycline-based chemotherapeutic regimens. Results show that the median overall survival (OS) time was 41 months. The 5-year OS and progression-free survival rates were 59.2 and 52.3%, respectively. The 5-year OS rate for patients who received RT alone was 57.9%, whereas that for patients who received RCT was 61.5% (P = 0.47). There is no significant difference between two treatment modalities. Multivariate analysis showed that Eastern Cooperative Oncology Group performance status (PS) score > or = 2, local tumor invasion out of nasal cavity, and lower complete remission (CR) rates in the initial treatment were significant unfavorable independent prognostic factors. Taken together, our study suggests that RCT did not improve the survival rate of patients with early stage NNTCL. PS score before treatment, local tumor invasion out of nasal cavity, and CR rate of the primary treatment may be independent prognostic factors among the subtype lymphoma entity.
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167
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Kim BS, Kim TY, Kim CW, Kim JY, Heo DS, Bang YJ, Kim NK. Therapeutic outcome of extranodal NK/T-cell lymphoma initially treated with chemotherapy--result of chemotherapy in NK/T-cell lymphoma. Acta Oncol 2009; 42:779-83. [PMID: 14690165 DOI: 10.1080/02841860310010682] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The therapeutic outcome of chemotherapy in NK/T cell lymphoma (NTCL) has not been well documented until now. The aims of this study were to investigate the outcome of chemotherapy and to evaluate the clinical factors influencing the responsiveness to chemotherapy. Between 1995 and 2000, 59 patients received anthracycline-based chemotherapy as an initial treatment. Forty-five patients had nasal NTCL, whereas 14 had extranasal NTCL. Forty-one patients had stage I/II and 18 had stage III/IV disease. Epstein-Barr virus status was positive in 67.6% of cases. The results of initial chemotherapy were complete remission in 35.6% of the patients, 2-year disease-free survival in 22.9% and 2-year overall survival in 44.2%. Adjuvant radiotherapy after chemotherapy did not improve outcome in stage I/II nasal NTCL. The International Prognostic Index was a significant prognostic factor of complete remission rate, and stage was also significant for disease-free survival.
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Affiliation(s)
- Byung Su Kim
- Department of Internal Medicine and Pathology, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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168
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Lee KW, Yun T, Kim DW, Im SA, Kim TY, Yoon SS, Heo DS, Bang YJ, Park S, Kim BK, Kim NK. First-line ifosfamide, methotrexate, etoposide and prednisolone chemotherapy ± radiotherapy is active in stage I/II extranodal NK/T-cell lymphoma. Leuk Lymphoma 2009; 47:1274-82. [PMID: 16923557 DOI: 10.1080/10428190600562823] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although most patients diagnosed with extranodal NK/T-cell lymphoma (NTCL) have localized disease, radiotherapy alone is unsatisfactory because of frequent systemic failure and conventional doxorubicin-based chemotherapy has low efficacy. Twenty-six patients with NTCL received ifosfamide, methotrexate, etoposide and prednisolone (IMEP) chemotherapy as first-line treatment [ifosfamide 1.5 g/m2 (days 1 - 3), methotrexate 30 mg/m2 (days 3 and 10), etoposide 100 mg/m2 (days 1 - 3) and prednisolone 120 mg (days 1 - 5)]. Radiotherapy was administered only to patients with Ann Arbor stage I/II that had not achieved complete remission (CR) or to those that developed local failure after completing chemotherapy. Sixteen patients (group A) had nasal or upper aerodigestive tract localization (stage I/II) and 10 (group B) had extranasal or disseminated disease. Of the 14 evaluable patients in group A, 11 (79%) achieved CR after IMEP alone and 13 (93%) after chemotherapy +/- additional radiotherapy. Although, out of the 11 patients who achieved CR with chemotherapy alone, seven developed recurrence, all recurrences were local failure and successfully treated by additional curative radiotherapy. However, patients in group B responded poorly (CR 13%). IMEP regimen was active in NTCL patients with nasal or upper aerodigestive tract localization. Considering local failure rate after IMEP alone, initial IMEP chemotherapy followed by radiotherapy may be a promising treatment strategy in this subset of NTCL.
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Affiliation(s)
- Keun-Wook Lee
- Department of Internal Medicine, Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Chongno-Gu, Seoul, Korea
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169
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Wenig BM. Undifferentiated malignant neoplasms of the sinonasal tract. Arch Pathol Lab Med 2009; 133:699-712. [PMID: 19415944 DOI: 10.5858/133.5.699] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2009] [Indexed: 11/06/2022]
Abstract
CONTEXT The most commonly encountered malignant neoplasms of the sinonasal tract are the keratinizing and nonkeratinizing types of squamous cell carcinoma. However, this complex anatomic region may represent the site of aggressive, non-squamous cell epithelial and nonepithelial malignant neoplasms of varying histogenesis, which are grouped under the term undifferentiated malignant neoplasms. Frequently, these undifferentiated malignancies share clinical and light microscopic features, which makes differentiation of one from the other virtually impossible without the use of adjunct analyses (eg, immunohistochemistry, electron microscopy, or molecular biologic studies). These tumors often are clinically aggressive and usually fatal, despite all attempts at controlling disease. Nevertheless, differentiating these tumors has clinical import because advances in therapeutic intervention may increase survival with good quality of life, and in some instances may achieve a cure. OBJECTIVE To compare and contrast the clinical, light microscopic, and immunohistochemical features of sinonasal undifferentiated malignant neoplasms. DATA SOURCES Case-derived material and literature review. CONCLUSIONS A variety of undifferentiated malignant neoplasms occur in the sinonasal tract with overlapping clinical and pathologic findings. In limited biopsy material, differentiation of these tumor types can be challenging. The pathologist plays a primary role in establishing the correct diagnosis, which often necessitates the use of adjunct studies that allow for differentiating among these neoplasms.
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Affiliation(s)
- Bruce M Wenig
- Department of Pathology and Laboratory Medicine, Beth Israel Medical Center, St. Luke's-Roosevelt Hospitals, New York, New York 10003, USA.
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170
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Kim BS, Kim DW, Im SA, Kim C, Kim TY, Yoon SS, Heo D, Bang YJ, Park S, Kim B, Kim N. Effective second-line chemotherapy for extranodal NK/T-cell lymphoma consisting of etoposide, ifosfamide, methotrexate, and prednisolone. Ann Oncol 2009; 20:121-8. [DOI: 10.1093/annonc/mdn551] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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171
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Ko HJ, Yang MY, Kim HJ, Yun JA, Kim HJ, Lee SC, Bae SB, Kim CK, Lee NS, Park SK, Lee KT, Won JH, Hong DS, Park HS, Kim HK. A Case of Solitary Involved NK-T Cell Lymphoma on the Gallbladder. THE KOREAN JOURNAL OF HEMATOLOGY 2009. [DOI: 10.5045/kjh.2009.44.4.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hee Ja Ko
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Mi Yean Yang
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Han Jo Kim
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Jin A Yun
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Sang Cheol Lee
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Sang Byung Bae
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Chan Kyu Kim
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Nam Su Lee
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Seong Kyu Park
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Kyu Teak Lee
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Jong Ho Won
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Dae Sik Hong
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Hee Sook Park
- Department of Internal Medicine, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
| | - Hee Kyung Kim
- Department of Pathology, University of Soonchunhyang Collage of Medicine, Bucheon, Korea
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172
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Lee J, Au WY, Park MJ, Suzumiya J, Nakamura S, Kameoka JI, Sakai C, Oshimi K, Kwong YL, Liang R, Yiu H, Wong KH, Cheng HC, Ryoo BY, Suh C, Ko YH, Kim K, Lee JW, Kim WS, Suzuki R. Autologous Hematopoietic Stem Cell Transplantation in Extranodal Natural Killer/T Cell Lymphoma: A Multinational, Multicenter, Matched Controlled Study. Biol Blood Marrow Transplant 2008; 14:1356-64. [DOI: 10.1016/j.bbmt.2008.09.014] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 09/14/2008] [Indexed: 10/21/2022]
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173
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Loong SLE, Hwang JSG, Lim ST, Yap SP, Tao M, Chong TW, Tan LHC, Huynh H. An Epstein-Barr virus positive natural killer lymphoma xenograft derived for drug testing. Leuk Lymphoma 2008; 49:1161-7. [PMID: 18452087 DOI: 10.1080/10428190802043879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Natural killer (NK) lymphomas occurring more frequently in the Far East and South America respond poorly to anthracycline-based regimens. Here we report an in vivo NK lymphoma xenograft (NK-S1) derived from the testicular metastasis of a patient with an extranodal NK lymphoma (nasal type). The NK-S1 xenograft, established in severe combined immune deficient (SCID) mice retained the same imunophenotypic features as the original tumor. NK-S1 disseminated intra-abdominally to the testis, intestine and liver. Although doxorubicin, rapamycin, bevacizumab, rapamycin-doxorubicin, and bevacizumab-doxorubicin had no effects on the growth of subcutaneous NK-S1 xenografts, intraperitoneal (IP) delivery of cyclophosphamide caused complete tumor regression; this tumor regression was associated with apoptosis, upregulation of activated caspase-3, and cleaved Poly(ADP-ribose) polymerase (PARP). In an IP model of NK lymphoma, cyclophosphamide also prolonged the survival of mice and potently inhibited tumor dissemination and ascites formation. Our data suggest that the NK-S1 xenograft is a useful tool for screening preclinical drugs, and cyclophosphamide may be a useful drug for the treatment of this disease.
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Affiliation(s)
- Susan Li Er Loong
- Division of Cellular and Molecular Research, Department of Radiation Oncology, National Cancer Centre, Singapore
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174
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Suh C, Kang YK, Roh JL, Kim MR, Kim JS, Huh J, Lee JH, Jang YJ, Lee BJ. Prognostic value of tumor 18F-FDG uptake in patients with untreated extranodal natural killer/T-cell lymphomas of the head and neck. J Nucl Med 2008; 49:1783-9. [PMID: 18927319 DOI: 10.2967/jnumed.108.053355] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Although 18F-FDG PET has been used to monitor patients with lymphoma, its usefulness has not been determined in patients with extranodal natural killer/T-cell lymphoma (ENKTL). Therefore, we evaluated whether pretreatment 18F-FDG uptake was a predictor of survival in patients with ENKTL of the head and neck. METHODS Pretreatment staging work-ups, including whole-body 18F-FDG PET, were performed on 21 patients with previously untreated head and neck ENKTL. Fourteen patients received combined chemoradiotherapy (n = 14), and 7 received chemotherapy or radiotherapy alone. We assessed the relationship of maximum standardized uptake value (SUVmax) of the tumor to disease-specific survival (DSS) and to clinical parameters, including sex, age, Ann Arbor stage, performance status, International Prognostic Index score, presence of B symptoms, lactate dehydrogenase level, local tumor invasion (LTI), and lymph node involvement. RESULTS Mean tumor SUVmax was 5.5 and was significantly higher in patients with elevated lactate dehydrogenase level, LTI, or poor response to initial therapy (P < 0.05). All 5 nonresponders to therapy had an SUVmax greater than 5.5, whereas 11 of 16 responders (69%) had an SUVmax less than or equal to 5.5 (mean SUVmax, 8.4 vs. 4.5). Univariate analysis showed that an International Prognostic Index score greater than or equal to 2, LTI, and SUVmax category were significant predictors of 3-y DSS, although only the SUVmax category remained an independent determinant of DSS on multivariate analysis (P = 0.023). CONCLUSION High tumor 18F-FDG uptake was closely associated with local tumor invasion, contributing to unfavorable treatment and survival outcomes in patients with ENKTL of the head and neck.
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Affiliation(s)
- Cheolwon Suh
- Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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175
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Karantanis D, Subramaniam RM, Peller PJ, Lowe VJ, Durski JM, Collins DA, Georgiou E, Ansell SM, Wiseman GA. The value of [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography in extranodal natural killer/T-cell lymphoma. ACTA ACUST UNITED AC 2008; 8:94-9. [PMID: 18501102 DOI: 10.3816/clm.2008.n.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To our knowledge, there are no published data pertinent to the use of [(18F)]fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with natural killer (NK)/T-cell lymphoma. The purpose of this study was to assess the value of FDG PET/CT in this aggressive type of non-Hodgkin lymphoma. PATIENTS AND METHODS All patients with NK/T-cell lymphoma referred for FDG PET/CT at our institution from July 2001 to July 2006 were retrospectively studied. PET/CT examinations were blindly reviewed by 2 experienced readers. The results were compared with the status of the disease, which was determined after evaluation of biopsy, laboratory, clinical and conventional imaging examination, and follow-up results. PET/CT results were thereby classified as true-positive, true-negative, false-positive, or false-negative. The degree of FDG uptake in the positive lesions was semiquantified using maximum standard uptake value (SUV(max)). RESULTS Twenty-one PET/CT examinations were performed in 10 patients with NK/T-cell lymphoma. For nasal disease, PET/CT was true-positive in 5 cases, true-negative in 15 cases, and positive but unconfirmed in 1 case. For extranasal disease, PET/CT was true-positive in 3 cases, true-negative in 16 cases, and false-negative in 2 cases. The mean SUV(max) in PET-positive lesions in nasal cavities or paranasal sinuses was 16 gm/mL (range, 5-25 gm/mL; median, 19.3 gm/mL). In extranasal disease, the mean SUV(max) was 10.9 gm/mL (range, 4.6-34.1 gm/mL; median, 5.6 gm/mL). CONCLUSION Viable NK/T-cell lymphoma is intensely FDG hypermetabolic. PET/CT appears to be sensitive for the detection of disease in the nasopharynx and, to a lesser extent, in extranasal sites.
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Affiliation(s)
- Dimitrios Karantanis
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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176
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Suzuki R, Takeuchi K, Ohshima K, Nakamura S. Extranodal NK/T-cell lymphoma: diagnosis and treatment cues. Hematol Oncol 2008; 26:66-72. [PMID: 18283711 DOI: 10.1002/hon.847] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extranodal NK/T-cell lymphoma, nasal type (ENKL) is mostly endemic to East Asia. It predominantly occurs in the nasal or paranasal areas and less frequently in the skin. Most of the tumours show NK-cell, but rarely T-cell, phenotypes. The Epstein-Barr virus (EBV) genome can be usually detected in lymphoma cells. Geographic localization of ENKL matches the endemic distribution of EBV, suggesting that EBV plays an important role in lymphomagenesis. Originally, NK-cell and T-cell types were believed to present the same clinicopathologic characteristics, but recent data suggest more aggressive characteristics for the NK-cell phenotype. Although ENKL is sensitive to radiotherapy, it shows a poorer response to chemotherapeutic agents than other lymphomas due to expression of p-glycoprotein. Therefore, new therapeutic approaches must be considered. Several new clinical trials are now being conducted in East Asia.
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Affiliation(s)
- Ritsuro Suzuki
- Department of HSCT Data Management, Nagoya University, School of Medicine, Nagoya, Japan.
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177
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Huang MJ, Jiang Y, Liu WP, Li ZP, Li M, Zhou L, Xu Y, Yu CH, Li Q, Peng F, Liu JY, Luo F, Lu Y. Early or Up-Front Radiotherapy Improved Survival of Localized Extranodal NK/T-Cell Lymphoma, Nasal-Type in the Upper Aerodigestive Tract. Int J Radiat Oncol Biol Phys 2008; 70:166-74. [DOI: 10.1016/j.ijrobp.2007.05.073] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 05/28/2007] [Accepted: 05/29/2007] [Indexed: 11/25/2022]
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178
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179
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Abstract
A nasal NK/T cell lymphoma is a very aggressive form of lymphoma. Patterns of relapse after treatment have not been systematically evaluated, and mediastinal nodal relapse at a primary site has never been documented. We describe here a 40-year old man who presented with a nasal obstruction caused by a protruding mass that was identified as a nasal NK/T cell lymphoma. The initial work-up, including chest and abdominopelvic computed tomography (CT) and positron emission tomography (PET), showed no regional or distant metastasis. A CT scan performed following three cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) showed that the mass had nearly disappeared. Radiation therapy undertaken following chemotherapy was given to the primary site. However, PET performed following radiotherapy revealed a single mediastinal lymphadenopathy, with no evidence of residual tumor in the nasal cavity. A biopsy using video-assisted thoracoscopy (VATS) showed the presence of a recurrent NK/T cell lymphoma with an immunophenotype identical to that of the primary nasal lymphoma. An additional three cycles of CHOP chemotherapy were administered, and the patient remains alive, with no evidence of disease 30 months after the initial relapse. These findings indicate that early detection with PET and prompt surgical excision with the use of VATS can lead to successful treatment of a relapsed nasal NK/T cell lymphoma.
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Affiliation(s)
- Kyoung Hoon Rhee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seok Chan Hong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Min An
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ryu Jin Sook
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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180
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Lee J, Suh C, Huh J, Jun HJ, Kim K, Jung C, Park K, Park YH, Ko YH, Kim WS. Effect of positive bone marrow EBV in situ hybridization in staging and survival of localized extranodal natural killer/T-cell lymphoma, nasal-type. Clin Cancer Res 2007; 13:3250-4. [PMID: 17545530 DOI: 10.1158/1078-0432.ccr-06-2373] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of the study was to determine the effect of EBV-encoded RNA-1 in situ hybridization (EBER-1 ISH) in bone marrow specimens on survival outcome in patients with clinical stage I/II natural killer/T-cell lymphoma. EXPERIMENTAL DESIGN We systematically did EBER-1 ISH on 182 archival bone marrow tissues from 91 patients who were diagnosed of stage I/II natural killer/T-cell lymphoma and analyzed the correlation between bone marrow EBER-1 ISH status and survival. We defined minimal bone marrow involvement and definite bone marrow involvement to distinguish the subgroups who revealed EBV-positive cells from normal marrow by EBER-1 ISH from those who showed typical neoplastic cells in bone marrow biopsies. RESULTS In total, 17 of the 91 (18.7%) patients showed positivity for EBER-1 ISH at least in one of the bilateral bone marrow biopsies with 14 minimal bone marrow involvements and 3 definite bone marrow involvements. Patients with positive bone marrow EBER-1 ISH showed significantly poorer overall survival than those who were negative for bone marrow EBER-1 ISH (median survival, 16.1 months versus not reached; P = 0.045). CONCLUSION Considering a high proportion of stage I/II patients (15.4%) with minimal in bone marrow specimens, bone marrow EBER-1 ISH should be routinely done in all patients with localized disease for more accurate staging.
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Affiliation(s)
- Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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181
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Kim SJ, Kim BS, Choi CW, Choi J, Kim I, Lee YH, Kim JS. Ki-67 expression is predictive of prognosis in patients with stage I/II extranodal NK/T-cell lymphoma, nasal type. Ann Oncol 2007; 18:1382-7. [PMID: 17693651 DOI: 10.1093/annonc/mdm183] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Localized extranodal natural killer (NK)/T-cell lymphoma, nasal type, commonly has a low or low-intermediate risk of the international prognostic index (IPI), so the IPI has shown inconsistency in predicting prognosis. Thus, we analyzed Ki-67 expression and proposed a new prognostic model including Ki-67 expression for stage I/II extranodal NK/T-cell lymphoma. PATIENTS AND METHODS We studied Ki-67 expression and its relationship with prognosis in 50 patients with extranodal NK/T-cell lymphoma. RESULTS The patients were dichotomized by the median value: low (<65%) versus high Ki-67 (> or =65%). High Ki-67 was associated with a worse overall survival (OS; P = 0.021) and disease-free survival (DFS; P = 0.044). In multivariate analysis, Ki-67 expression and primary site of involvement were found to be an independent prognostic factor for OS and DFS (P < 0.05). Based on these results, we proposed a new clinico-pathological prognostic model with Ki-67 expression and the primary site of involvement. It showed a high degree of correlation with worse OS and DFS (P < 0.001). CONCLUSIONS Ki-67 expression is predictive of prognosis, and our prognostic model may become a useful tool for predicting prognosis in patients with stage I/II extranodal NK/T-cell lymphoma, nasal type.
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Affiliation(s)
- S J Kim
- Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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182
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Panwalkar AW, Armitage JO. T-cell/NK-cell lymphomas: A review. Cancer Lett 2007; 253:1-13. [PMID: 17196327 DOI: 10.1016/j.canlet.2006.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 11/17/2006] [Accepted: 11/21/2006] [Indexed: 11/26/2022]
Abstract
T-cell neoplasms are a group of heterogeneous neoplasms that present a challenge in management. Accurate diagnosis and classification are necessary for proper treatment. This dilemma is exemplified by continuous upgrading of classification systems in an effort to better understand these diseases. The spectrum of management varies from observation and monitoring to prompt aggressive multimodality treatment to achieve optimal outcomes. Allogeneic transplant has been successful in a minority of cases with the possibility of cure; however this approach is still largely experimental. Molecular studies such as gene expression profiling are expected to offer exciting insight into the biology of these diseases. Novel therapeutic approaches continue to be explored, however will probably require larger clinical trials to establish their utility over the current standard.
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Affiliation(s)
- Amit W Panwalkar
- University of Nebraska Medical Center, Department of Oncology/Hematology, 987680 Nebraska Medical Center, Omaha, NE 68198-7680, United States.
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183
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Na II, Kang HJ, Park YH, Lee SS, Yoo HJ, Choe DH, Ryoo BY, Yang SH. Prognostic factors for classifying extranodal NK/T cell lymphoma, nasal type, as lymphoid neoplasia. Eur J Haematol 2007; 79:1-7. [PMID: 17598834 DOI: 10.1111/j.1600-0609.2007.00876.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study evaluated the applicability of prognostic factors commonly used for diagnosis of classical lymphoma outcomes to extranodal NK/T cell lymphoma, nasal type (NTCL). Clinical features and their associations with lactate dehydrogenase (LDH) were evaluated in 70 patients. RLDH was defined as the ratio of LDH to the upper normal limit. RLDH was associated with stage (I-II vs. III-IV), lymph node involvement (LNI), and International Prognostic Index score (<2 vs. > or =2). Poor performance status and advanced stage were common in patients with local tumor invasiveness (LTI). LDH level, classified into three levels (low, high, and very high) was associated with survival (P < 0.001). In multivariate analysis, the predictive values of LDH level, B symptom, performance status, and stage remained significant whereas those of LTI and LNI did not. Scoring was performed by weighting each factor with 0.5 or 1.0 according to its hazard ratio. Scores were classified into four groups. Groups with high scores were associated with unfavorable outcomes (P < 0.001). Current study suggests that prognostic factors for NHL may be useful to predict the outcome of NTCL but the model should take LDH level and the prognostic weight of each factor into account.
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Affiliation(s)
- Im I Na
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
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184
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Wang B, Lu JJ, Ma X, Guo Y, Lu H, Hong X, Li J. Combined chemotherapy and external beam radiation for stage IE and IIE natural killer T-cell lymphoma of nasal cavity. Leuk Lymphoma 2007; 48:396-402. [PMID: 17325902 DOI: 10.1080/10428190601059795] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To evaluate the outcome of CHOP chemotherapy and radiotherapy in Stage IE and IIE nasal natural killer (NK)/T-cell lymphoma, 53 patients with stage IE and IIE nasal NK/T-cell lymphoma were studied. By the Ann Arbor Lymphoma Staging Classification, 41 patients (77%) had Stage IE disease and 12 patients (23%) had Stage IIE disease. All patients were treated curatively using chemotherapy, followed by radiotherapy. Chemotherapy consisted of up to six cycles of the standard CHOP based regimen. The median radiation dose to the tumor bed was 45 Gy for all patients. The median follow-up for all 39 surviving patients was 30.2 months (range, 6 - 104 months). Twenty-six patients had complete response after chemotherapy, and all patients who completed first line chemotherapy achieved complete response after radiotherapy. The 2-year overall survival and progression-free survival rates were 75.6% and 61.8%, respectively. Multivariate analysis revealed that perforation as a presenting symptom, elevated pretreatment serum lactate dehydrogenase level, and ECOG performance status >or=2 were significant independent prognostic factors for this group of patients. Combined chemotherapy followed by involved field radiation produced suboptimal outcome for patients with early stage nasal NK/T-cell lymphoma. Further investigations, preferably prospective clinical trials, for more efficacious treatment strategies are needed to improve the treatment outcome of this malignancy.
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Affiliation(s)
- Biyun Wang
- Department of Medical Oncology, Cancer Hospital of Fudan University, Shanghai, People's Republic of China
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185
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Kim SJ, Kim BS, Choi CW, Seo HY, Seol HR, Sung HJ, Kim IS, Kim CY, Jung KY, Kim JS. Treatment outcome of front-line systemic chemotherapy for localized extranodal NK/T cell lymphoma in nasal and upper aerodigestive tract. Leuk Lymphoma 2007; 47:1265-73. [PMID: 16923556 DOI: 10.1080/10428190600565651] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We analysed the treatment outcome of localized extranodal NK/T cell lymphoma initially treated with CEOP-B chemotherapy based on the primary site of involvement (nasal cavity vs. upper aerodigestive tract) and treatment modality (chemotherapy vs. chemotherapy followed by radiotherapy. Forty-three patients newly diagnosed as extranodal NK/T cell lymphoma were analysed: 29 cases from nasal cavity/nasopharynx and 14 from upper aerodigestive tract. Twenty-six patients were treated with chemotherapy alone, while adjuvant radiotherapy was given to 17 patients. Overall response rate to front-line CEOP-B chemotherapy was 67.4% (29/43) and the complete remission (CR) rate was 44.2% (19/43). Median overall and disease-free survival was 26.87 months [95% confidence interval (CI) = 8.71 - 45.03] and 15.27 months (95% CI = 2.92 - 27.62). The responders (CR or partial response) to initial CEOP-B chemotherapy showed longer overall survival than non-responders (P = 0.0026). Local relapse was observed to be higher in the chemotherapy alone group compared to the chemoradiotherapy group. Adjuvant radiotherapy failed to improve survival; thus, the median disease-free survival of the chemotherapy and chemoradiotherapy groups was not different (P = 0.9101). There may be a tendency for better overall survival in group of upper aerodigestive tract lymphoma than the nasal cavity/nasopharynx group (P = 0.0643). However, front-line CEOP-B chemotherapy has a limited role and adjuvant radiotherapy failed to improve survival in localized extranodal NK/T cell lymphoma.
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Affiliation(s)
- Seok Jin Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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186
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Shim SJ, Yang WI, Shin E, Koom WS, Kim YB, Cho JH, Suh CO, Kim JH, Kim GE. Clinical significance of cyclooxygenase-2 expression in extranodal natural killer (NK)/T-cell lymphoma, nasal type. Int J Radiat Oncol Biol Phys 2007; 67:31-8. [PMID: 17049184 DOI: 10.1016/j.ijrobp.2006.07.1387] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 07/20/2006] [Accepted: 07/28/2006] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine whether there are any differences in therapeutic response, patterns of systemic recurrence, and prognosis of patients with extranodal natural killer (NK)/T-cell lymphoma, nasal type, by the cyclooxygenase-2 (COX-2) expression. PATIENTS AND METHODS Thirty-four patients with Ann Arbor Stage I and II extranodal NK/T-cell lymphoma who underwent chemotherapy or radiotherapy, or both, were retrospectively reviewed. These patients were divided into two groups according to their immunohistochemical staining for COX-2 expressions: a COX-2-negative group (n = 10 patients) and a COX-2-positive group (n = 24 patients). The treatment response, patterns of treatment failure, and survival data for the patients were compared between the COX-2-positive and negative groups. RESULTS There was no significant difference in the clinical profiles between the COX-2-negative and COX-2-positive groups. All patients (100%) in the COX-2-negative group achieved complete response after initial treatment, whereas only 14 patients (58%) in the COX-2-positive group achieved complete response (p = 0.03). Compared with the patients in the COX-2-negative group, those in the COX-2-positive group had a significantly lower 2-year systemic recurrence-free survival rate (100% for the COX-2-negative group vs. 54% for the COX-2-positive group) (p = 0.02) and a decreased 5-year overall survival rate (70% for the COX-2-negative group vs. 32% for the COX-2-positive group) (p = 0.06). CONCLUSION Cyclooxygenase-2 expression can serve as a predictive factor for poor treatment response, higher systemic recurrence, and unfavorable prognosis in patients with extranodal NK/T-cell lymphoma, nasal type.
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Affiliation(s)
- Su Jung Shim
- Department of Radiation Oncology, Yonsei Cancer Center, Brain Korea 21 Project for Medical Sciences, Yonsei University, College of Medicine, Seoul, Republic of Korea
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Yokoyama H, Yamada MF, Ishizawa K, Yamamoto J, Tomiya Y, Harigae H, Kameoka J, Ichinohasama R, Sasaki T. Successful Treatment of Advanced Extranodal NK/T Cell Lymphoma with Unrelated Cord Blood Transplantation. TOHOKU J EXP MED 2007; 211:395-9. [PMID: 17409680 DOI: 10.1620/tjem.211.395] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nasal natural killer (NK)/T cell lymphoma is a rare entity of non-Hodgkin's lymphoma which mostly occurs in East Asian countries. The advanced disease above clinical stage III is often refractory to the radiation and chemotherapies, remission is transient even if achieved, and median survival is about 12 months. Thus the prognosis of advanced NK/T cell lymphoma is generally poor, however, the promising results of allogeneic hematopoietic stem cell transplantation for advanced NK/T cell lymphoma have been recently reported. In most of these cases, stem cell sources were human leukocyte antigen (HLA) matched donors and alternative sources were seldom used. We report here a case of a 36-year-old woman who was diagnosed as having an extranodal NK/T cell lymphoma, nasal type. The patient achieved a complete remission after 2 cycles of chemotherapy including Carboplatin, Etoposide, Ifosfamide, and Dexamethasone, but 3-months later relapsed during the search for HLA-matched unrelated donors. She received unrelated cord blood transplantation (CBT) in the second remission achieved by a regimen containing L-asparaginase. The conditioning regimen was 12 Gy of total body irradiation, high-dose cytarabin and cyclophosphamide. FK506 and methotrexate were used for graft-versus-host disease (GVHD) prophylaxis. GVHD involving the intestine and the oral mucosa was observed, but improved without additional immunosuppressive therapies. The patient remains in remission 33 months after CBT. Cord blood thus could be an appropriate stem cell source for patients with advanced NK/T lymphoma who have no HLA matched donors.
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Affiliation(s)
- Hisayuki Yokoyama
- Department of Rheumatology and Hematology, Tohoku University Graduate School of Medicine, Sendai, Japan
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188
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Bossard C, Belhadj K, Reyes F, Martin-Garcia N, Berger F, Kummer JA, Brière J, Baglin AC, Cheze S, Bosq J, Ribrag V, Gisselbrecht C, Mounier N, Gaulard P. Expression of the granzyme B inhibitor PI9 predicts outcome in nasal NK/T-cell lymphoma: results of a Western series of 48 patients treated with first-line polychemotherapy within the Groupe d'Etude des Lymphomes de l'Adulte (GELA) trials. Blood 2006; 109:2183-9. [PMID: 17077322 DOI: 10.1182/blood-2006-07-033142] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
AbstractNasal NK/T-cell lymphoma is a rare disease entity with a poor outcome. Expression of antiapoptotic proteins has not been extensively investigated in this entity. Forty-eight patients with nasal T/NK-cell lymphoma who received first-line polychemotherapy (n = 44) or chemoradiotherapy (n = 4) were analyzed for expression of active caspase-3 (aC3), granzyme B protease inhibitor 9 (PI9), and Bcl-2 proteins. Lymphomas were CD3+/CD5−/granzyme B+ and EBV-associated. Median age was 46 years. Stage I/II disease was present in 75% of the cases and an International Prognostic Index (IPI) score less than 1 in 65%. With a median follow-up of 6.3 years, 5-year event-free survival (EFS) and overall survival (OS) rates were 39% and 49%, respectively. Apoptotic index was scored as high in 32% of cases and PI9 expression as positive in 68%, whereas 35% disclosed a high number of aC3+ tumor cells. Univariate analysis showed that absence of PI9 and low apoptotic index were associated with poor outcome, but not aC3 expression nor IPI score. By multivariate analysis, both parameters affected independently EFS (P = .02 and .08, respectively) and OS (P = .009 and .04). In view of its constitutive expression by normal NK cells, it is suggested that loss of PI9 expression in tumor cells may reflect some mechanism associated with progression.
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Affiliation(s)
- Céline Bossard
- Département de Pathologie and Institut National de la Santé et de la Recherche Médicale (Inserm) Unité (U) 617, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
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189
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Al-Hakeem DA, Fedele S, Carlos R, Porter S. Extranodal NK/T-cell lymphoma, nasal type. Oral Oncol 2006; 43:4-14. [PMID: 17064952 DOI: 10.1016/j.oraloncology.2006.03.011] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 03/13/2006] [Accepted: 03/20/2006] [Indexed: 11/19/2022]
Abstract
Extranodal NK/T-cell lymphoma, nasal type (ENKTCL), previously known as lethal midline granuloma is a distinct clinico-pathological entity associated with Epstein-Barr virus that typically causes destruction of the midface, palatal and orbital walls. In addition, ENKTCL can involve the skin, soft tissue, testes, gastrointestinal and upper respiratory tract. ENKTCL neoplastic cells express some T-cell associated antigens, most commonly CD2 and cytoplasmic CD3epsilon and, in favour of an NK-cell origin, CD56. Early stage disease may respond to radiotherapy alone, however late stage disease does not respond well to any available therapies. Overall, patients with ENKTCL have a cumulative probability of survival at 5 years ranging from 37.9% to 45.3%.
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Affiliation(s)
- Dalal Abdullah Al-Hakeem
- Oral Medicine Unit, Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, UCL Eastman Dental Institute for Oral Health Care Sciences, 256 Gray's Inn Road, London WC1X 8LD, UK
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190
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Tham IWK, Lee KM, Yap SP, Loong SLE. Outcome of patients with nasal natural killer (NK)/T-cell lymphoma treated with radiotherapy, with or without chemotherapy. Head Neck 2006; 28:126-34. [PMID: 16240328 DOI: 10.1002/hed.20314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study reviews the outcome of patients with nasal natural killer (NK)/T-cell lymphoma treated at the Therapeutic Radiology Department, National Cancer Centre, Singapore, from 1997 to 2003. METHODS Twenty-one consecutive patients treated with radiotherapy, with or without chemotherapy, were retrospectively reviewed. RESULTS The median age was 44 years (range, 27-86 years). Thirteen patients had stage I disease, five had stage II disease, and three had stage IV disease. Immunophenotyping was CD 56+ in 18 patients. Median follow-up for patients still alive was 23.4 months (range, 8.9-78.5 months). A median dose of 50 Gy (range, 35-56 Gy) was delivered. Sixteen patients also received chemotherapy. Two-year overall survival was 52.8%. Five patients had rapidly progressive disease, with a median survival of 89 days from diagnosis. The other 16 patients had complete remission, after which four relapsed. There were two local relapses. CONCLUSIONS This disease often carries a poor prognosis, despite multimodality treatment. Radiotherapy may contribute to local control in some patients.
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Affiliation(s)
- Ivan Weng Keong Tham
- Therapeutic Radiology Department, National Cancer Centre, 11 Hospital Drive, Singapore 169610
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191
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Kim HJ, Bang SM, Lee J, Kwon HC, Suh C, Kim HJ, Lee JH, Ryoo BY, Park YH, Kwon JM, Oh SY, Lee HR, Kim K, Jung CW, Park K, Kim WS. High-dose chemotherapy with autologous stem cell transplantation in extranodal NK/T-cell lymphoma: a retrospective comparison with non-transplantation cases. Bone Marrow Transplant 2006; 37:819-24. [PMID: 16547486 DOI: 10.1038/sj.bmt.1705349] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To determine the role of high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) in extranodal NK/T-cell lymphoma patients, we conducted a retrospective analysis. In our previous study, we searched for patients who had received HDC/ASCT and identified 16 eligible patients and compared the treatment outcome with historical control group (n=246). Nine patients received HDC/ASCT in the first (CR1) or second complete remission (CR2), while seven patients received HDC/ASCT as salvage. Twelve of 16 patients achieved or maintained CR after HDC/ASCT. Among the 12 patients, five patients relapsed. Estimated 2-year overall survival (OS) and relapse-free survival (RFS) rates were 71.3+/-12.4% and 25.8+/-14.3%, respectively. There was a tendency of better survival in patients who received HDC/ASCT as compared to those who did not (P=0.091). In subset analysis, patients who underwent HDC/ASCT at CR (P=0.049) and patients with stage III or IV (P=0.001) had a favorable outcome. Patients with NKIPI 3,4 or EUNKTL, who underwent HDC/ASCT had more prolonged survival without statistical significance (P=0.055 and 0.056). In conclusion, HDC/ASCT may be considered as a treatment option for patients with extranodal NK/T-cell lymphoma, especially those in CR, with advanced disease (stage III/IV or EUNKTL) and high NKIPI scores.
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Affiliation(s)
- H J Kim
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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192
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Li YX, Yao B, Jin J. In Reply:. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.06.3289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Bo Yao
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
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193
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Cho HI, Hong YS, Lee MA, Kim EK, Yoon SH, Kim CC, Kim TG. Adoptive transfer of Epstein-Barr virus-specific cytotoxic T-lymphocytes for the treatment of angiocentric lymphomas. Int J Hematol 2006; 83:66-73. [PMID: 16443556 DOI: 10.1532/ijh97.a30505] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Angiocentric lymphoma, known as natural killer (NK)/T-cell non-Hodgkin's lymphoma, has been reported to be associated with the Epstein-Barr virus (EBV). We performed adoptive transfer of EBV-specific polyclonal T-cell lines in 3 patients with extranodal NK/T-cell lymphoma, nasal type, and evaluated the treatment for safety, immunologic reconstitution, and clinical outcomes. The tissue samples collected from the 3 patients were confirmed by polymerase chain reaction analysis to be EBV positive. In the cases of the first and second patients, EBV-transformed B-lymphoblastoid cell lines (LCLs) and T-cell lines were generated from peripheral lymphocytes of HLA-matched sibling donors. The third patient's T-cell lines were induced with autologous lymphocytes. Polyclonal T-cell infusion was carried out after high-dose radiotherapy because active relapsed disease remained in all of the patients. The first patient received 4 weekly infusions of 2 3 10(7) cells/m(2), and the second and third patients underwent treatment with 2 cycles of infusions of the same dosage. All T-cell lines showed >60% NK activity, cytotoxic T-lymphocyte (CTL) responses of >40% against autologous LCLs, and no CTL activity against patient-derived lymphoblasts. The level of cytotoxicity increased substantially in all patients after cell infusion. The 2 patients who received T-cell therapy twice had stabilized disease for more than 3 years. These safe treatments exhibited no severe inflammatory response, and no serious toxicity developed during T-cell therapy. Our findings demonstrate that adoptively transferred cells may provide reconstitution of EBV-specific CTL responses in patients with active relapsed angiocentric lymphoma. These results provide a rationale for the immunotherapy of angiocentric lymphoma.
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MESH Headings
- Adult
- Cell Line
- Disease-Free Survival
- Epstein-Barr Virus Infections/pathology
- Epstein-Barr Virus Infections/therapy
- Herpesvirus 4, Human
- Humans
- Immunotherapy, Adoptive/methods
- Killer Cells, Natural/pathology
- Killer Cells, Natural/virology
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Lymphoma, Non-Hodgkin/virology
- Male
- Nose Neoplasms/pathology
- Nose Neoplasms/therapy
- Nose Neoplasms/virology
- T-Lymphocytes, Cytotoxic/pathology
- T-Lymphocytes, Cytotoxic/transplantation
- T-Lymphocytes, Cytotoxic/virology
- Treatment Outcome
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Affiliation(s)
- Hyun-Il Cho
- Department of Microbiology and Immunology, Catholic Research Institute of Medical Science, College of Medicine, The Catholic University of Korea, Seocho-Ku, Seoul, 137-701, Korea
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194
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Bahnassy AA, Zekri ARN, Asaad N, El-Houssini S, Khalid HM, Sedky LM, Mokhtar NM. Epstein-Barr viral infection in extranodal lymphoma of the head and neck: correlation with prognosis and response to treatment. Histopathology 2006; 48:516-28. [PMID: 16623777 DOI: 10.1111/j.1365-2559.2006.02377.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To determine the prevalence of Epstein-Barr virus (EBV) infection in primary extranodal lymphoma of the head and neck (PELHN) in immunocompetent patients. PELHN represents 16.18% of all lymphoma diagnosed at the National Cancer Institute, Cairo. Although EBV infection is highly associated with lymphoma in immunocompromised patients, the situation in immunocompetent patients is still unclear. MATERIAL AND METHODS The study included 50 PELHN (11 cases in the nose and paranasal sinuses, 11 in the nasopharynx, 13 in the tonsils, seven in the oropharynx and eight in the oral cavity), five reactive lymph nodes, 15 normal nasopharyngeal tissue and 25 throat washes of healthy subjects from Egypt. Cases and controls were assessed for the presence of EBV by polymerase chain reaction (PCR) and in situ hybridization techniques, the presence of 30 base pair deletion of the LMP-1 (del-LMP1) gene and for the expression of p53, Ki67, bcl-2 and Bax by immunohistochemistry. This was also correlated with the clinical outcome of patients. RESULTS EBV was detected in 90% and 70% of the cases using EBER in situ hybridization and PCR, respectively. All cases of nasal type lymphoma were positive for EBV. del-LMP1 gene was detected in 24/35 of EBV+ cases (68.6%), whereas 11 cases had wild-type variant either alone or mixed with del-LMP1. There was a significant difference in the frequency of del-LMP1 between lymphoma and normal tissues. Overexpression of Ki67, p53 and bcl-2 was detected in 78.1%, 62.5% and 20% of cases, whereas loss of Bax was detected in 18% of the cases. Multivariate analysis showed that only p53 overexpression, del-LMP1 variant and advanced disease stage are independent prognostic factors. CONCLUSION EBV infection is frequent in PELHN in Egypt. Possible pathogenic mechanisms involve deregulation of p53 and enhanced proliferation (as detected by high Ki67 index). The presence of del-LMP1 variants, p53 overexpression and advanced disease stage are poor prognostic factors associated with reduced survival and poor response to therapy.
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Affiliation(s)
- A A Bahnassy
- Pathology Department, Menofya University, Cairo, Egypt.
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195
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Hirose Y, Masaki Y, Sawaki T, Shimoyama K, Karasawa H, Kawabata H, Fukushima T, Ogawa N, Wano Y, Umehara H. Association of Epstein-Barr virus with human immunodeficiency virus-negative peripheral T-cell lymphomas in Japan. Eur J Haematol 2006; 76:109-18. [PMID: 16405431 DOI: 10.1111/j.0902-4441.2005.00575.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The association of Epstein-Barr virus (EBV) with human immunodeficiency virus-negative T-cell lymphoma was examined in 68 patients using the polymerase chain reaction (PCR) with DNA obtained from formalin-fixed paraffin-embedded tissues and an in situ hybridization technique. EBV-encoded RNA (EBER) was detected in 43 of 68 cases (63%) of peripheral T-cell lymphoma: in 100% (11 of 11 cases) of NK/T-cell lymphomas, 70% (14 of 20 cases) of angioimmunoblastic T-cell lymphomas (AILT) and 49% (18 of 37 cases) of other types of peripheral T-cell lymphoma. A positive band was also detected at high incidence (36 of 65 cases; 55%) in a PCR analysis using primers to detect the Bam HI-W fragment of EBV. In the immunohistochemical analysis using a monoclonal antibody to latent membrane protein 1 (LMP-1) of EBV, one of the EBV-encoded latent gene products, LMP-1, was found to be expressed in 13 of 64 cases (20%), but EBNA-2 was not expressed in all the cases examined (0 of 59 cases; 0%). The 5-yr survival rate was 28% for peripheral T-cell lymphomas overall, 0% for NK/T-cell lymphomas, 38% for AILTs and 28% for other types of peripheral T-cell lymphoma. The difference in the overall survival rate between NK/T-cell lymphoma and non-NK/T-cell lymphoma was significant (P = 0.0498 by Log-rank test). Among peripheral T-cell lymphoma patients overall, the group severely infected with EBV (EBER-ISH ++) had a lower 5-yr survival rate (8%) than the group slightly (EBER-ISH +) or not infected (38%; P = 0.0013).
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Affiliation(s)
- Yuko Hirose
- Department of Hematology and Immunology, Kanazawa Medical University, Ishikawa, Japan.
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196
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Li YX, Yao B, Jin J, Wang WH, Liu YP, Song YW, Wang SL, Liu XF, Zhou LQ, He XH, Lu N, Yu ZH. Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma. J Clin Oncol 2006; 24:181-9. [PMID: 16382127 DOI: 10.1200/jco.2005.03.2573] [Citation(s) in RCA: 281] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED PURPOSE The optimal therapy remains unclear for nasal natural killer (NK)/T-cell lymphoma. The purpose of this study is to analyze the outcome of radiotherapy as the primary treatment for localized stage IE and IIE diseases. PATIENTS AND METHODS One hundred five patient cases were reviewed. There were 83 stage IE and 22 stage IIE patients. All except three patients received radiotherapy (RT) alone or RT combined with chemotherapy (CT; combined-modality therapy [CMT]). Overall, 31 patients were treated with RT alone, 34 with RT followed by CT, 37 with CT followed by RT, and three with CT alone. RESULTS Five-year overall survival (OS) and progression-free survival (PFS) for all patients were 71% and 59%, respectively. The 5-year OS and PFS were 78% and 63% for stage IE, and 46% and 40% for stage IIE, respectively. Complete response (CR) was achieved in 91 patients (87%) after RT and/or CT. Initial RT resulted in a superior CR as compared with initial CT, with 54 (83%) of 65 patients achieving CR with initial RT, versus only eight (20%) of 40 after initial CT. For 102 patients who received RT with or without CT, the outcome of primary treatment with RT alone was compared with that of CMT. Five-year OS and PFS was 66% and 61% for RT alone, and 76% and 61%% for CMT, respectively (OS, P = .6433; PFS, P = .8391). CONCLUSION RT as primary therapy resulted in good outcome in early-stage disease, and the addition of CT to RT was not accompanied by an improvement in survival.
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Affiliation(s)
- Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
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197
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Lee J, Suh C, Park YH, Ko YH, Bang SM, Lee JH, Lee DH, Huh J, Oh SY, Kwon HC, Kim HJ, Lee SI, Kim JH, Park J, Oh SJ, Kim K, Jung C, Park K, Kim WS. Extranodal Natural Killer T-Cell Lymphoma, Nasal-Type: A Prognostic Model From a Retrospective Multicenter Study. J Clin Oncol 2006; 24:612-8. [PMID: 16380410 DOI: 10.1200/jco.2005.04.1384] [Citation(s) in RCA: 543] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with natural killer T (NK/T) -cell lymphomas have poor survival outcome, and for this condition there is no optimal therapy. The purpose of this study was to design a prognostic model specifically for extranodal NK/T-cell lymphoma, which can identify high-risk patients who need more aggressive therapy. Patients and Methods This multicenter retrospective study was comprised of 262 patients who were diagnosed with NK/T-cell lymphoma. Results After a median follow-up duration of 51.2 months, 5-year overall survival rate in 262 patients was 49.5%. Prognostic factors for survival were “B” symptoms (P = .0003; relative risk, 2.202; 95% CI, 1.446 to 3.353), stage (P = .0006; relative risk, 2.366; 95% CI, 1.462 to 3.828), lactate dehydrogenase (LDH) level (P = .0005; relative risk, 2.278; 95% CI, 1.442 to 3.598), and regional lymph nodes (P = .0044; relative risk, 1.546; 95% CI, 1.009 to 2.367). Of 262 patients, 219 had complete information on four parameters. We identified four different risk groups: group 1, no adverse factor; group 2, one factor; group 3, two factors; and group 4, three or four factors. The new model showed a superior prognostic discrimination as compared with the International Prognostic Index (IPI). Notably, the distribution of patients was balanced when a new model was adopted (group 1, 27%; group 2, 31%; group 3, 20%; group 4, 22%), whereas 81% of patients were categorized as low or low-intermediate risks using IPI. Conclusion The newly proposed model for extranodal NK/T-cell lymphoma demonstrated a more balanced distribution of patients into four groups with better prognostic discrimination as compared with the IPI.
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Affiliation(s)
- Jeeyun Lee
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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198
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Isobe K, Uno T, Tamaru JI, Kawakami H, Ueno N, Wakita H, Okada JI, Itami J, Ito H. Extranodal natural killer/T-cell lymphoma, nasal type. Cancer 2006; 106:609-15. [PMID: 16369986 DOI: 10.1002/cncr.21656] [Citation(s) in RCA: 170] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to investigate the correlation between local recurrence and radiotherapeutic parameters, including dose and RT radiotherapy (RT) field. METHODS The current study included 35 patients who were diagnosed with immunohistochemically confirmed nasal natural killer (NK)/T-cell lymphoma between 1976 and 2004. There were 21 males and 14 females, and they ranged in age from 18 years to 76 years (median, 51 yrs). The primary tumor originated in the nasal cavity in 28 patients, and 32 patients had Stage I disease. Seventeen patients received treatment solely with RT, and the remaining 18 patients received a combination of chemotherapy and RT. The median tumor dose was 50 grays (Gy) (range, 22-60 Gy). Twenty-seven patients received RT to include all macroscopic lesions, all paranasal sinuses, the palate, and the nasopharynx. Eight patients received RT to all macroscopic lesions with generous margins. RESULTS A complete remission (CR) or a CR/unconfirmed was achieved in 28 patients (80%). The 5-year overall survival (OAS) rate, disease-free survival (DFS) rate, and local control probability (LCP) were 47.3%, 42.9%, and 65.2%, respectively. Patients who received RT only to macroscopic lesions fared less well in terms of LCP (LCP 5 years, 71.9% vs. 41.7%; P=0.007). The difference in RT field also affected both the OAS rate and the DFS rate. Patients who received RT doses>or=50 Gy tended to achieve favorable local control. CONCLUSIONS In the management of nasal NK/T-cell lymphoma, the RT field affected treatment outcomes. RT doses>or=50 Gy resulted in favorable local control.
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Affiliation(s)
- Koichi Isobe
- Department of Radiology, Chiba University Hospital, Chiba, Japan.
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199
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Suzuki R, Suzumiya J, Nakamura S, Kagami Y, Kameoka JI, Sakai C, Mukai H, Takenaka K, Yoshino T, Tsuzuki T, Sugimori H, Kawa K, Kodera Y, Oshimi K. Hematopoietic stem cell transplantation for natural killer-cell lineage neoplasms. Bone Marrow Transplant 2006; 37:425-31. [PMID: 16400344 DOI: 10.1038/sj.bmt.1705244] [Citation(s) in RCA: 170] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neoplasms of natural killer (NK)-lineage are rare. Their prognosis is generally poor except for cases of solitary nasal NK-cell lymphoma. The NK-cell Tumor Study Group performed a survey in Japan on patients diagnosed between 1994 and 1998. Of 228 patients selected for analysis, 40 underwent HSCT (15 allografts and 25 autografts). The underlying diseases were myeloid/NK cell precursor acute leukemia (n = 4), blastic NK-cell lymphoma (n = 11), aggressive NK-cell leukemia (n = 3), and nasal-type extranodal NK-cell lymphoma (n = 22). At the time of HSCT, 22 patients were in complete remission (CR), 11 were in relapse, and seven were primary refractory. All patients received myeloablative conditioning regimens including total-body irradiation. Sixteen died of disease progression, and six of treatment-related causes. Overall, 4-year survival was 39% with a median follow-up of 50 months; this was significantly better than that of patients who did not undergo HSCT (21%, P = 0.0003). For patients transplanted in CR, the 4-year overall survival was 68%, which was significantly better than that of patients who went into CR but did not undergo HSCT (P = 0.03). These findings suggest that the HSCT is a promising treatment strategy for NK-cell lineage.
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Affiliation(s)
- R Suzuki
- Division of Molecular Medicine, Aichi Cancer Center, Kanokoden, Nagoya, Japan.
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Kim TM, Park YH, Lee SY, Kim JH, Kim DW, Im SA, Kim TY, Kim CW, Heo DS, Bang YJ, Chang KH, Kim NK. Local tumor invasiveness is more predictive of survival than International Prognostic Index in stage IE/IIE extranodal NK/T-cell lymphoma, nasal type. Blood 2005; 106:3785-90. [PMID: 16109779 DOI: 10.1182/blood-2005-05-2056] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study was launched to determine the prognostic significance of local tumor invasiveness (LTI) in 114 patients diagnosed with stage IE/IIE extranodal natural killer (NK)/T-cell lymphoma, nasal type (NTCL). LTI was defined as bony invasion or destruction or tumor invasion of the skin. Complete remission (CR), overall survival (OS), and disease-free survival (DFS) were compared between each group according to LTI, Ann Arbor stage, and International Prognostic Index (IPI). LTI was observed in 23 patients. Using multivariate analysis, factors associated with low probability of CR were the presence of LTI (P < .001), the presence of B symptoms (P = .003), and single-modality chemotherapy (P = .045). The presence of LTI (relative risk [RR] = 8.4, 95% confidence interval [CI] 3.9-17.9; P < .001) and high IPI score (RR = 2.8, 95% CI 1.2-6.8; P = .019) were also predictive of OS. The presence of LTI (RR = 7.3, 95% CI 3.2-16.5; P < .001) was an independently significant factor for reduced DFS. Ann Arbor staging system did not predict CR, OS, or DFS but IPI did have predictive power with regard to survival outcome. LTI is the most important prognostic factor in predicting low probability of CR and reduced OS and DFS in nasal stage IE/IIE NTCL.
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Affiliation(s)
- Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
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