151
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Wang YQ, Yang Y, Zhuo HY, Zou LQ, Jiang Y, Jiang M. Trial of LVDP regimen (L-asparaginase, etoposide, dexamethasone, and cisplatin, followed by radiotherapy) as first-line treatment for newly diagnosed, stage III/IV extranodal natural killer/T cell lymphoma. Med Oncol 2015; 32:435. [PMID: 25572807 DOI: 10.1007/s12032-014-0435-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/03/2014] [Indexed: 02/05/2023]
Abstract
Stage III/IV extranodal natural killer/T cell lymphoma (ENKL) has a poor response and poor survival. Given the sensitivity of ENKL to radiotherapy and the fact that there is no consensus on standard chemotherapy, we conducted a clinical trial of LVDP regimen, combining LVDP chemotherapy (containing etoposide, dexamethasone, L-asparaginase, and cisplatin), followed by radiotherapy as a consolidation therapy regimen, for newly diagnosed patients with stage III/IV ENKL to evaluate the efficacy and safety of this regimen. The primary endpoints were overall response rate (ORR) and survival [overall survival (OS) and progression-free survival (PFS)] at 1 or 2 years, while the secondary endpoints were toxicity and adverse effects. In total, 18 patients were enrolled in this trial from July 2010 to September 2013. The mean completed cycles of chemotherapy was 4.04 (range 1-8 cycles), and the ORR was 50 %. During a mean follow-up of 21.8 months (range 2-51 months), the 1-year OS and PFS rates were 72.2 and 50.0 %, respectively, the 2-year OS and PFS rates were 33.3 and 22.2 %, respectively, and the median OS and PFS were 23.0 and 10.5 months, respectively. Severe adverse effects during therapy included six cases of grade 3/4 bone marrow suppression and one case of grade 3 transaminase increase. Sex, eastern cancer oncology group, performance status, Korean Prognostic Index, International Prognostic index, and bone marrow infiltration may influence the prognosis of advanced-stage ENKL.
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Affiliation(s)
- Y Q Wang
- Center of Medical Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China,
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152
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Corradini P, Marchetti M, Barosi G, Billio A, Gallamini A, Pileri S, Pimpinelli N, Rossi G, Zinzani P, Tura S. SIE-SIES-GITMO Guidelines for the management of adult peripheral T- and NK-cell lymphomas, excluding mature T-cell leukaemias. Ann Oncol 2014; 25:2339-2350. [DOI: 10.1093/annonc/mdu152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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153
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Early radiotherapy has an essential role for improving survival in patients with stage I-II nasal-type of NK/T cell lymphoma treated with l-asparaginase-containing chemotherapy—a single institution experience. Ann Hematol 2014; 94:583-91. [DOI: 10.1007/s00277-014-2244-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
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154
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Kontny U, Oschlies I, Woessmann W, Burkhardt B, Lisfeld J, Salzburg J, Janda A, Attarbaschi A, Niggli F, Zimmermann M, Reiter A, Klapper W. Non-anaplastic peripheral T-cell lymphoma in children and adolescents - a retrospective analysis of the NHL-BFM study group. Br J Haematol 2014; 168:835-44. [DOI: 10.1111/bjh.13216] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/03/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Udo Kontny
- Division of Paediatric Haematology, Oncology and Stem Cell Transplantation; Department of Paediatrics and Adolescent Medicine; University Medical Centre; Aachen Germany
| | - Ilske Oschlies
- Department of Pathology, Haematopathology Section and Lymph Node Registry; University of Kiel; Kiel Germany
| | - Willi Woessmann
- Department of Paediatric Haematology and Oncology; NHL-BFM-Study Centre; Justus Liebig University; Giessen Germany
| | - Birgit Burkhardt
- Department of Paediatric Haematology and Oncology; NHL-BFM-Study Centre; University Children's Hospital; Münster Germany
| | - Jasmin Lisfeld
- Department of Paediatric Haematology and Oncology; NHL-BFM-Study Centre; Justus Liebig University; Giessen Germany
| | - Janina Salzburg
- Department of General Paediatrics; University Medical Centre Schleswig-Holstein; Kiel Germany
| | - Ales Janda
- Centre for Paediatrics and Adolescent Medicine; University Medical Centre; Freiburg Germany
| | - Andishe Attarbaschi
- Department of Paediatric Haematology and Oncology; St. Anna Children's Hospital; Vienna Austria
- Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Felix Niggli
- Department of Paediatric Haematology and Oncology; University Children's Hospital Zürich; Zürich Switzerland
| | - Martin Zimmermann
- Department of Paediatric Haematology and Oncology; Medical School Hannover; Hannover Germany
| | - Alfred Reiter
- Department of Paediatric Haematology and Oncology; NHL-BFM-Study Centre; Justus Liebig University; Giessen Germany
| | - Wolfram Klapper
- Department of Pathology, Haematopathology Section and Lymph Node Registry; University of Kiel; Kiel Germany
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155
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Lymphopenia during routine follow-up may predict relapse in patients with extranodal NK/T cell lymphoma. Tumour Biol 2014; 36:1747-53. [PMID: 25366140 DOI: 10.1007/s13277-014-2776-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/23/2014] [Indexed: 12/31/2022] Open
Abstract
Recently, absolute lymphocyte count (ALC) at diagnosis, as a surrogate marker of host immunity, has been reported to be a prognostic factor for clinical outcomes in extranodal NK/T cell lymphoma (ENKTL). In this retrospective study, we set out to investigate whether ALC at the time of confirmed relapse or at last follow-up is a marker for relapse after chemoradiotherapy in 84 patients with stage I/II ENKTL. Receiver operating characteristics (ROC) curve and area under the curve (AUC) analysis showed that ALC at follow-up was a significant marker for relapse (AUC = 0.883, P < 0.001). Using 1.215 × 10(9)/L as the optimal cutoff value of ALC, 44 patients (52.4%) were in lower ALC group and 40 patients (47.6%) were in higher ALC group. The sensitivity and specificity for ALC at the time of confirmed relapse or at last follow-up was 94.1 and 76.0%, respectively. The relative risk of relapse with an ALC < 1.215 × 10(9)/L was 14.5. The positive predictive value with an ALC < 1.215 × 10(9)/L was 72.7%, and the negative predictive value with an ALC ≥ 1.215 × 10(9)/L was 95.0%. The 4-year cumulative incidence rate for an ALC < 1.215 × 10(9)/L was 73.2% compared with 3.2% for an ALC ≥ 1.215 × 10(9)/L (P < 0.001). In a multivariate regression analysis, ALC at the time of confirmed relapse or last follow-up remained to be a significant factor for relapse (P < 0.001). In conclusion, lymphopenia observed during routine follow-up can predict relapse in patients with ENKTL, which needs further validation in prospective trials.
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Tsai HJ, Lin SF, Chen CC, Chen TY, Su WC, Hwang WL, Lin JC, Chiou TJ, Kao WY, Chiu CF, Chang YF, Chang JS, Chang MC, Su IJ. Long-term results of a phase II trial with frontline concurrent chemoradiotherapy followed by consolidation chemotherapy for localized nasal natural killer/T-cell lymphoma. Eur J Haematol 2014; 94:130-7. [DOI: 10.1111/ejh.12405] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Hui-Jen Tsai
- National Institute of Cancer Research; National Health Research Institutes; Tainan Taiwan
- Division of Hematology/Oncology; Department of Internal Medicine; National Cheng Kung University Hospital; Tainan Taiwan
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Sheng-Fung Lin
- Division of Hematology/Oncology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
- Faculty of Medicine; College of Medicine; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Chu-Chih Chen
- Division of Biostatistics and Bioinformatics; Institute of Population Health Sciences; National Health Research Institutes; Zhunan Taiwan
| | - Tsai-Yun Chen
- Division of Hematology/Oncology; Department of Internal Medicine; National Cheng Kung University Hospital; Tainan Taiwan
| | - Wu-Chou Su
- Division of Hematology/Oncology; Department of Internal Medicine; National Cheng Kung University Hospital; Tainan Taiwan
| | - Wen-Li Hwang
- Division of Hematology/Oncology; Department of Internal Medicine; Taichung Veterans General Hospital; Taichung Taiwan
| | - Jin-Ching Lin
- Department of Radiation Oncology; Taichung Veterans General Hospital; Taichung Taiwan
| | - Tzeon-Jye Chiou
- Division of Transfusion Medicine; Department of Medicine; Taipei Veterans General Hospital and National Yang-Ming University School of Medicine; Taipei Taiwan
| | - Weio-Yau Kao
- Department of Internal Medicine; Tri-Service General Hospital; Taipei Taiwan
- Division of Hematology/Oncology; Department of Internal Medicine; Buddhist Taipei Tzu Chi Hospital; Taipei Taiwan
| | - Chang-Fang Chiu
- Division of Hematology/Oncology; Department of Internal Medicine; China Medical University Hospital; Taichung Taiwan
| | - Yi-Fang Chang
- Division of Hematology/Oncology; Department of Internal Medicine; Mackay Memorial Hospital; Taipei Taiwan
| | - Jeffrey S. Chang
- National Institute of Cancer Research; National Health Research Institutes; Tainan Taiwan
| | - Ming-Chih Chang
- Division of Hematology/Oncology; Department of Internal Medicine; Mackay Memorial Hospital; Taipei Taiwan
| | - Ih-Jen Su
- National Institute of Infectious Diseases and Vaccinology; National Health Research Institutes; Tainan Taiwan
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157
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Deng T, Zhang C, Zhang X, Wu S, Xu Y, Liu S, Chen X. Treatment outcome of radiotherapy alone versus radiochemotherapy in IE/IIE extranodal nasal-type natural killer/T cell lymphoma: a meta-analysis. PLoS One 2014; 9:e106577. [PMID: 25184382 PMCID: PMC4153679 DOI: 10.1371/journal.pone.0106577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 08/07/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Previous studies have revealed conflicting findings concerning the efficacy of radiotherapy (RT) and radiochemotherapy (RCT) in IE/IIE extranodal nasal-type natural killer/T cell lymphoma (ENKTL). In this study, we conducted a comprehensive meta-analysis to address this issue. METHODS We systematically searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EmBase, BISOS, Clinical Trials and some Chinese databases for relevant studies, and 2 prospective and 15 retrospective studies involving a total of 1595 patients met our inclusion criteria. RESULTS The meta-analysis showed no significant differences in complete remission (CR) [odds ratio (OR) 0.85, 95% confidence interval (CI) 0.42-1.72, p = 0.65], 5-year overall survival (OS) [hazard ratio (HR) 1.11, 95% CI 0.85-1.45, p = 0.43] and 5-year progression free survival (PFS) (HR 1.07, 95% CI 0.75-1.53, p = 0.70) in patients who received RT versus RCT. Furthermore, the addition of CT decreased neither systemic failure (SL) (OR 0.75, 95% CI 0.47-1.21, p = 0.24) nor locoregional failure (LF) (OR 1.17, 95% CI 0.68-2.01, p = 0. 57). CONCLUSIONS RCT did not have an obvious advantage over RT for treating IE/IIE ENKTL.
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Affiliation(s)
- Tianxia Deng
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Sha Wu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Yaqi Xu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Shanshan Liu
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Xinghua Chen
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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158
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Wang H, Wuxiao ZJ, Zhu J, Wang Z, Wang KF, Li S, Chen X, Lu Y, Xia ZJ. Comparison of gemcitabine, oxaliplatin and L-asparaginase and etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone as first-line chemotherapy in patients with stage IE to IIE extranodal natural killer/T-cell lymphoma: a multicenter retrospective study. Leuk Lymphoma 2014; 56:971-7. [PMID: 24991715 DOI: 10.3109/10428194.2014.939964] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optimal chemotherapy regimen for Extranodal natural killer/T-cell lymphoma (ENKTL) has not yet been defined. We retrospectively compared the outcome of 93 patients newly diagnosed with stage IE to IIE ENKTL who received gemcitabine, oxaliplatin and L-asparaginase (GELOX) (n = 40) or etoposide, vincristine, doxorubicin, cyclophosphamide and prednisone (EPOCH) (n = 53) as induction chemotherapy. After induction chemotherapy, the complete response (CR) rate and overall response rate (ORR) for the GELOX group were higher than those for the EPOCH group (70.0% vs. 41.5%, p = 0.007 for CR; 87.5% vs. 67.9%, p = 0.047 for ORR). The GELOX regimen resulted in significantly superior 5-year progression-free survival (PFS) (79.0% vs. 46.5%, p = 0.005) and overall survival (OS) rates (78.9% vs. 50.4%, p = 0.003). Toxicity of both regimens was acceptable. The GELOX regimen produces a better long outcome with less toxicity than the EPOCH regimen for patients with early stage ENKTL.
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Affiliation(s)
- Hua Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center , Guangzhou, Guangdong , P. R. China
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159
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Guo HQ, Liu L, Wang XF, Lin TY, Yao SN, Yao ZH, Yang SJ. Efficacy of gemcitabine combined with oxaliplatin, L-asparaginase and dexamethasone in patients with newly-diagnosed extranodal NK/T-cell lymphoma. Mol Clin Oncol 2014; 2:1172-1176. [PMID: 25279218 DOI: 10.3892/mco.2014.368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/21/2014] [Indexed: 12/17/2022] Open
Abstract
There is currently no standard first-line regimen for patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTCL). In this study, we investigated the efficacy and toxicity of gemcitabine (GEM) combined with oxaliplatin (L-OHP), L-asparaginase (L-ASP) and dexamethasone (DXM) (GOLD regimen) as a systemic treatment scheme for newly-diagnosed ENKTCL cases. A total of 55 patients were recruited at the Henan Province Cancer Hospital and the Cancer Center of Sun Yat-sen University between May, 2008 and August, 2012. The GOLD regimen included a 14-day treatment cycle with GEM (1,000 mg/m2) on day 1, L-OHP (100 mg/m2) on day 1, L-ASP (10,000 U/m2) on days 1-5 and DXM (20 mg b.i.d.) on days 1-4. The response rate, survival rate and treatment toxicity were analyzed. The overall response rate was 91% (48/55) with a complete response in 62% (34/55) and a partial response in 29% (15/55) of the patients. For all patients, the 1-, 2- and 3-year progression-free survival (PFS) rate was 86, 64 and 57% and the overall survival (OS) 91, 80 and 74%, respectively. The 1-year PFS in patients with stage I/II vs. those with III/IV disease was 87 vs. 66% (P<0.001) and the 1-year OS was 98 vs. 75%, respectively (P<0.001). No chemotherapy-related mortality or severe complications were recorded. In conclusion, the GOLD regimen was found to be highly effective and safe for the treatment of patients with newly-diagnosed ENKTCL.
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Affiliation(s)
- Hong-Qiang Guo
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China ; Department of Medical Oncology, Henan Province Cancer Hospital, Zhengzhou, Henan 450008, P.R. China
| | - Lei Liu
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China ; Department of Medical Oncology, Henan Province Cancer Hospital, Zhengzhou, Henan 450008, P.R. China
| | - Xin-Feng Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China ; Department of Medical Oncology, Henan Province Cancer Hospital, Zhengzhou, Henan 450008, P.R. China
| | - Tong-Yu Lin
- Department of Medical Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, P.R. China
| | - Shu-Na Yao
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China ; Department of Medical Oncology, Henan Province Cancer Hospital, Zhengzhou, Henan 450008, P.R. China
| | - Zhi-Hua Yao
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China ; Department of Medical Oncology, Henan Province Cancer Hospital, Zhengzhou, Henan 450008, P.R. China
| | - Shu-Jun Yang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450008, P.R. China ; Department of Medical Oncology, Henan Province Cancer Hospital, Zhengzhou, Henan 450008, P.R. China
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160
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Moncada B, Sobrevilla-Ondarza S, Md JDM. Radiotherapy supports a better outcome than chemotherapy in cutaneous natural killer (NK)/T cell lymphoma nasal type. Int J Dermatol 2014; 52:1276-7. [PMID: 24073909 DOI: 10.1111/j.1365-4632.2011.05196.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin Moncada
- Department of Dermatology and Hospital Central "Dr Ignacio Morones Prieto" Universidad Autónoma de San Luis Potosí (Independent University of San Luis Potosi) San Luis PotosiMexicoDepartment of Otolaryngology Hospital Central "Dr Ignacio Morones Prieto" Universidad Autónoma de San Luis Potosí (Independent University of San Luis Potosi) San Luis PotosiMexico E-mail:
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161
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Ji J, Liu T, Xiang B, Liu W, He C, Chen X, Li J, Chang H, Dai Y, Dong T. A study of gemcitabine,l-asparaginase, ifosfamide, dexamethasone and etoposide chemotherapy for newly diagnosed stage IV, relapsed or refractory extranodal natural killer/T-cell lymphoma, nasal type. Leuk Lymphoma 2014; 55:2955-7. [DOI: 10.3109/10428194.2014.907894] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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162
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Abstract
Cutaneous T-cell lymphomas (CTCLs), other than mycosis fungoides/Sézary syndrome and the group of cutaneous CD30(+) lymphoproliferative disorders, are rare. These include subcutaneous panniculitis-like T-cell lymphoma (SPTCL); extranodal natural killer/T-cell lymphoma, nasal type; primary cutaneous peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS); and rare subtypes of PTCL, NOS. Apart from SPTCL and primary cutaneous CD4-positive small-medium pleomorphic T-cell lymphoma, these lymphomas have in common aggressive clinical behavior and poor prognosis. Differentiation between these different types of CTCL may be difficult and requires integration of histopathologic findings with clinical data and the results of phenotypic and often molecular genetic studies.
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Affiliation(s)
- Rein Willemze
- Department of Dermatology, Leiden University Medical Center, B1-Q-93, PO Box 9600, Leiden 2300 RC, The Netherlands.
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163
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Zhao Z, Liao Y, Li J, Wu J, Zhang Y, Feng G, Tan B, Reng S, Zhang Z, Feng X, Wang J, Du X. Association between higher expression of YB-1 and poor prognosis in early-stage extranodal nasal-type natural killer/T-cell lymphoma. Biomark Med 2014; 8:581-8. [PMID: 24796623 DOI: 10.2217/bmm.14.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aim: A recent study shows that YB-1-related biomarkers affect the prognosis of patients with natural killer/T-cell lymphoma (NKTCL). The aim of this study was to determine whether there is an association between YB-1 expression and the prognosis of patients with early-stage extranodal nasal-type NKTCL. Materials & methods: To clarify the roles of YB-1 in early-stage extranodal nasal-type NKTCL, we used immunohistochemical studies to examine YB-1 expression in 36 early-stage extranodal nasal-type NKTCL specimens. Results: Subsequently, YB-1 expression was correlated with clinicopathologic parameters. Higher expression of YB-1 was associated with an increased potential for relapse, poor disease-free survival and reduced overall survival. Discussion: Higher expression of YB-1 could be an independent risk factor for poor prognosis in patients with early-stage extranodal nasal-type NKTCL. Understanding the biology of YB-1-mediated pathways may lead to novel therapeutic strategies for early-stage extranodal nasal-type NKTCL.
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Affiliation(s)
- Zhenhua Zhao
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
| | - Yao Liao
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
- The Second Internal Department, The Affiliated Tumor Hospital of Guangzhou Medical College, Guangzhou, People’s Republic of China
| | - Jie Li
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
- Department of Oncology, Attached Hospital to North Sichuan Medical College, Sichuan, People’s Republic of China
| | - Jingbo Wu
- Department of Oncology, Affiliated Hospital of Luzhou Medical College, Sichuan, People’s Republic of China
| | - Yu Zhang
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
| | - Gang Feng
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
| | - Bangxian Tan
- Department of Oncology, Attached Hospital to North Sichuan Medical College, Sichuan, People’s Republic of China
| | - Surong Reng
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
| | - Zhikui Zhang
- Guangzhou Kingmed Center For Clinical Laboratory, Guangzhou, People’s Republic of China
| | - Xioaodong Feng
- Guangzhou Kingmed Center For Clinical Laboratory, Guangzhou, People’s Republic of China
| | - Jin Wang
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
| | - Xiaobo Du
- Department of Oncology, Mian Yang Central Hospital, Sichuan, People’s Republic of China
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164
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Zhang J, Zhu MY, Wang L, Wang H, Wang WD, Geng QR, Lu Y. "Sandwich" Chemotherapy (CT) with Radiotherapy (RT) improves outcomes in patients with stage IE/IIE extranodal natural killer (NK)/T-cell Lymphomas. Asian Pac J Cancer Prev 2014; 14:4061-6. [PMID: 23991953 DOI: 10.7314/apjcp.2013.14.7.4061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The extranodal natural killer/T-cell lymphoma (ENKTL) shows high local or systemic failure rates when radiotherapy (RT) is taken as the primary treatment, suggesting a role for chemotherapy (CT) added to RT for this disease. However, the appropriate mode of combined modality therapy (CMT) has not been fully defined. A total of one hundred and twenty-one patients with ENKTL receiving sandwich CT with RT were reviewed between January 2003 and August 2012. The primary endpoints were the response rate, progression-free survival (PFS), overall survival (OS), and the relapse rate. After the initial CT, there were 84 (69.4%) patients in CR, 22 (18.2%) patients in PR, 9 (7.4%) patients in SD, and 6 (5%) patients in PD, respectively. At the end of RT, the CR, PR, SD, and PD rates for all patients were 90.9% (n=110), 1.7% (n=2), 4.1% (n=5), and 3.3% (n=4), respectively. After a median follow-up of 42.3 months (3.5~112.3 months), the 5-year PFS was 74.7% (95% CI 70.4%~79.0%), and 5-year OS was 77.3% (95% CI 67.9%~86.7%). Disease progression was documented in 25 (20.7%) patients. The rates of systemic failure, local failure, and regional failure were 18.2%, 5.8%, 1.7%, respectively. Twenty death events (16.5%) were observed for the entire group of patients (18 deaths related to PD). Furthermore, CR to the initial CT and low Korean Prognostic Index (KPI) can independently predict long PFS and OS. The sandwich CMT achieved an excellent outcome for localized ENKTL with acceptable toxicity. We recommend it can be applied as the optimal choice for localized ENKTL.
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Affiliation(s)
- Jing Zhang
- Department of Hematologic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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165
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166
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Fang H, Jin J, Wang WH, Wang SL, Zhou LQ, Li YX. Prognostic factors and treatment outcomes for patients with stage II extranodal nasal-type natural killer/T-cell lymphoma of the upper aerodigestive tract. Leuk Lymphoma 2014; 55:1832-7. [DOI: 10.3109/10428194.2013.852668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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167
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Liu QF, Wang WH, Wang SL, Liu YP, Huang WT, Lu N, Zhou LQ, Ouyang H, Jin J, Li YX. Immunophenotypic and clinical differences between the nasal and extranasal subtypes of upper aerodigestive tract natural killer/T-cell lymphoma. Int J Radiat Oncol Biol Phys 2014; 88:806-13. [PMID: 24495590 DOI: 10.1016/j.ijrobp.2013.12.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/01/2013] [Accepted: 12/04/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE To investigate, in a large cohort of patients, the immunophenotypic and clinical differences of nasal and extranasal extranodal nasal-type natural killer/T-cell lymphoma of the upper aerodigestive tract (UADT-NKTCL) and examine the relevance of the immunophenotype on the clinical behavior, prognosis, and treatment. METHODS AND MATERIALS A total of 231 patients with UADT-NKTCL were recruited. One hundred eighty-one patients had primary location in the nasal cavity (nasal UADT-NKTCL), and 50 patients had primary extranasal UADT-NKTCL. RESULTS Patients with extranasal UADT-NKTCL had more adverse clinical features, including advanced-stage disease, regional lymph node involvement, B symptoms, and poor performance status, than patients with nasal UADT-NKTCL. In addition, CD56 and granzyme B were less frequently expressed in extranasal UADT-NKTCL. The 5-year overall survival rate was 74.1% for the entire group and 76.0% for early-stage disease. The 5-year overall survival rate for extranasal UADT-NKTCL was similar or superior to that of nasal UADT-NKTCL for all disease stages (76.9% vs 73.4%, P=.465), stage I disease (75.9% vs 79.2%, P=.786), and stage II disease (83.3% vs 50.3%, P=.018). CD56 expression and a Ki-67 proliferation rate ≥ 50% predicted poorer survival for extranasal UADT-NKTCL but not for nasal UADT-NKTCL. CONCLUSIONS Patients with nasal and extranasal UADT-NKTCL have significantly different clinical features, immunophenotypes, and prognosis. Extranasal UADT-NKTCL should be considered as a distinct subgroup apart from the most commonly diagnosed prototype of nasal UADT-NKTCL.
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Affiliation(s)
- Qing-Feng Liu
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei-Hu Wang
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shu-Lian Wang
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yue-Ping Liu
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wen-Ting Huang
- Department of Pathology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ning Lu
- Department of Pathology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Li-Qiang Zhou
- Department of Medical Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Han Ouyang
- Department of Radiology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Jin
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
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168
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Lunning MA, Horwitz S. Treatment of peripheral T-cell lymphoma: are we data driven or driving the data? Curr Treat Options Oncol 2014; 14:212-23. [PMID: 23568456 DOI: 10.1007/s11864-013-0232-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Peripheral T-cell lymphomas (PTCL) are a group of uncommon and heterogeneous malignancies arising from a postthymic or mature T-lymphocyte. The treatment of PTCL remains a challenging endeavor. Compared with the more common aggressive B-cell lymphomas, more patients with PTCL will be refractory to initial therapy and those who achieve responses often will have shorter progression-free survival. Despite retrospective data that suggest that anthracycline-based multiagent chemotherapy regimens may not provide a benefit compared with nonanthracycline regimens, nonanthracycline-based regimens, with the notable exception of L-asparaginase regimens for extranodal NK/T-cell lymphoma, have been disappointing so far. Based on phase II evidence and subset analyses available, we believe that the addition of etoposide to standard regimens and consolidation of first remissions with autologous stem cell transplantation (autoSCT) provides the best outcome in patients with PTCL and currently use CHOEP followed by ASCT for eligible patients with the common PTCL subtype: PTCL-NOS, AITL, and ALK negative ALCL. For those with ALK-positive ALCL standard CHOP or CHOEP is appropriate with consideration of ASCT only for those with high-risk disease. Other strategies to incorporate additional agents, such as with dose-adjusted EPOCH or sequential CHOP-ICE regimens are logical options; however, they lack the supporting literature of CHOEP. Whereas the above recommendation is our current off-protocol approach, with the possible exception of low risk ALK positive ALCL, none of these choices is supported by strong enough data to supplant a well-conceived clinical trial as the truly preferred strategy in PTCL. The novel agents, romidepsin, pralatrexate, and brentuximab vedotin, are currently approved in the relapsed/refractory setting. These agents are being studied as additions or substitutions for other agents in up-front multiagent chemotherapy regimens. In the relapsed/refractory setting, both pralatrexate and romidepsin remain well-studied choices with some patients achieving a response with durability. Clinical trials of new agents in PTCL continue to be a valuable option and an important part of routine patient management as progressive disease often is seen. Lastly, we believe patients with relapsed/refractory PTCL should be considered for allogeneic stem cell transplantation if a suitable response is demonstrated and a willing donor is available.
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Affiliation(s)
- Matthew A Lunning
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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169
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Riet FG, Canova CH, Gabarre J, Ben Hassine S, Kamsu Kom L, Mazeron JJ, Feuvret L. [Radiation therapy of sinonasal natural killer/T-cell lymphoma]. Cancer Radiother 2014; 18:147-53; quiz 161, 163. [PMID: 24462054 DOI: 10.1016/j.canrad.2013.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 11/18/2022]
Abstract
Natural killer (NK)/T-cell lymphoma are part of lymphoproliferative diseases, they are rare in Europe and the United States but relatively common in Asia and South America. Natural killer (NK)/T-cell lymphoma present clinically as destructive lesions of the upper aerodigestive tract with perforation of deep structures of the face, destruction of the palate or an invasion of orbits. Treatment modalities of these lymphomas are still discussed because of the lack of available studies and the rarity of this disease. Radiotherapy provides a rapid control of the disease and is positioned as a major treatment of localized stages of NK/T-cell lymphoma of the nasal cavity. We therefore studied the different forms of radiation therapy in the early stages of nasal NK/T-cell lymphoma.
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Affiliation(s)
- F-G Riet
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - C-H Canova
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - J Gabarre
- Service d'hépatologie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - S Ben Hassine
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - L Kamsu Kom
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - J-J Mazeron
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - L Feuvret
- Service d'oncologie radiothéapie, groupe hospitalier Pitié-Salpêtrière (AP-HP), 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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170
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Lee J, Kim CY, Park YJ, Lee NK. Sequential chemotherapy followed by radiotherapy versus concurrent chemoradiotherapy in patients with stage I/II extranodal natural killer/T-cell lymphoma, nasal type. Blood Res 2013; 48:274-81. [PMID: 24466552 PMCID: PMC3894386 DOI: 10.5045/br.2013.48.4.274] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/10/2013] [Accepted: 11/14/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The purpose of this report is to summarize our clinical experience of patients with stage I/II extranodal natural killer (NK)/T-cell lymphoma, nasal type, treated using sequential chemotherapy followed by radiotherapy (SCRT) or concurrent chemoradiotherapy (CCRT). METHODS Forty-three patients with stage I/II extranodal NK/T-cell lymphoma, nasal type, who received SCRT (16 patients) or CCRT (27 patients) were included in the present analysis. RESULTS The median follow-up time was 39 months (range, 4-171 months) for all patients, 77 months (range, 4-171 months) for the SCRT group, and 31 months (range, 6-132 months) for the CCRT group. There were no statistically significant differences between the SCRT and CCRT groups with regard to the 3-year progression-free survival (PFS) (56% vs. 41%, P=0.823) and 3-year overall survival (OS) (75% vs. 59%, P=0.670). Univariate analysis revealed that patients with tumors confined to the nasal cavity and patients achieved complete remission had better PFS and OS rates, regardless of the treatment sequence. Multivariate analysis revealed that patients with tumors confined to the nasal cavity and patients aged ≤60 years had better OS rates. CONCLUSION The effect of SCRT and CCRT are similar in terms of survival outcomes of patients with stage I/II extranodal NK/T-cell lymphoma, nasal type. Our results show that tumors confined to the nasal cavity and an age ≤60 years were associated with a better prognosis.
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Affiliation(s)
- Jieun Lee
- Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Chul Yong Kim
- Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Young Je Park
- Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Nam Kwon Lee
- Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
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171
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High-Dose and Extended-Field Intensity Modulated Radiation Therapy for Early-Stage NK/T-Cell Lymphoma of Waldeyer's Ring: Dosimetric Analysis and Clinical Outcome. Int J Radiat Oncol Biol Phys 2013; 87:1086-93. [DOI: 10.1016/j.ijrobp.2013.08.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/19/2013] [Accepted: 08/27/2013] [Indexed: 11/22/2022]
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172
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Abstract
Extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKL) is one of the uncommon subtypes of malignant lymphoma, and predominantly occurs in the nasal or paranasal areas and less frequently in the skin. Previously, its prognosis was poor due to the expression of P-glycoprotein, which actively exports several anticancer agents outside the lymphoma cells. However, in recent years, novel therapeutic approaches such as simultaneous chemoradiotherapy or l-asparaginase-based regimens including SMILE (steroid, methotrexate, ifosfamide, l-asparaginase, and etoposide) improved the response to therapy and survival of ENKL patients. Epstein-Barr virus (EBV) is present in lymphoma cells of almost all patients, accounting for the pathogenesis of ENKL. Fragmented EBV-DNA is released from tumor cells, and can be detected in the peripheral blood of patients. The EBV-DNA copy numbers are associated with tumor burden, and can predict the prognosis of ENKL, as well as the toxicity against chemotherapy. Based on this recent progress, ENKL is currently categorized as a lymphoma with intermediate prognosis, but the overall treatment results are not satisfactory. Further improvement of the prognosis of ENKL is therefore warranted, including the optimal use of hematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- Ritsuro Suzuki
- Department of HSCT Data Management and Biostatistics, Nagoya University, Graduate School of Medicine, Nagoya, Japan.
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173
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Karlin L, Coiffier B. The changing landscape of peripheral T-cell lymphoma in the era of novel therapies. Semin Hematol 2013; 51:25-34. [PMID: 24468313 DOI: 10.1053/j.seminhematol.2013.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Peripheral T-cell lymphomas (PTCLs) are the most common sub-entity of mature T-cell lymphomas, and apart from particular presentations, share a poor prognosis with frequent short-term, agressive, and chemorefractory relapses. Because of the rarity and also the heterogeneity of the disease, we lack randomized clinical trials. However, to date, neither intensification of frontline chemotherapy or autologous transplant has led to any improvement of survival, and the standard CHOP (cyclophosphamide, doxorubicine, vincristine, and prednisone) regimen remains the most employed as induction therapy. In the past few years, new chemotherapeutic agents, with the capability to encompass the resistance to conventional chemotherapy, such as pralatrexate or bendamustine, have been evaluated. Furthermore, identification of cell surface molecular markers (CD52, CD30, CCR4) has led to the development of new monoclonal antibodies. Similarly, the better comprehension of physiopathological mechanisms and detection of deregulated intracellular pathways encouraged the use of novel therapies such as histone deacetylase inhibitors or immunomodulatory drugs. Some of these compounds have been approved for relapse, and are currently evaluated upfront in ongoing clinical trials. Despite these efforts, the global prognosis still remains much inferior to those of B-cell lymphomas, highlighting the necessity of multicenter clinical trials.
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Affiliation(s)
- Lionel Karlin
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hematology Department, Pierre-Benite, France
| | - Bertrand Coiffier
- Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hematology Department, Pierre-Benite, France.
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174
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Armitage JO. The aggressive peripheral T-cell lymphomas: 2013. Am J Hematol 2013; 88:910-8. [PMID: 24078271 DOI: 10.1002/ajh.23536] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 06/28/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND T-cell lymphomas make up approximately 10-15% of lymphoid malignancies. The frequency of these lymphomas varies geographically, with the highest incidence in parts of Asia. DIAGNOSIS The diagnosis of aggressive peripheral T-cell lymphoma (PTCL) is usually made using the WHO classification. The ability of hematopathologists to reproducibly diagnosis aggressive PTCL is lower than for aggressive B-cell lymphomas, with a range of 72-97% for the aggressive PTCLs. RISK STRATIFICATION Patients with aggressive PTCL are staged using the Ann Arbor Classification. Although somewhat controversial, PET scans appear to be useful as they are in aggressive B-cell lymphomas. The most commonly used prognostic index is the International Prognostic Index. The specific subtype of aggressive PTCL is an important risk factor, with the best survival seen in anaplastic large cell lymphoma-particularly young patients with the anaplastic lymphoma kinase positive subtype. RISK ADAPTED THERAPY Anaplastic large cell lymphoma is the only subgroup to have a good response to a CHOP-like regimen. Angioimmunoblastic T-cell lymphoma has a prolonged disease-free survival in only ~20% of patients, but younger patients who have an autotransplant in remission seem to do better. PTCL-NOS (not otherwise specified) is not one disease. Anthracycline containing regimens have disappointing results and a new approach is needed. NK/T-cell lymphoma localized to the nose and nasal sinuses seems to be best treated with radiotherapy containing regimens. Enteropathy associated PTCL and hepatosplenic PTCL are rare disorders with a generally poor response to therapy, although selected patients with enteropathy associated PTCL seem to benefit from intensive therapy.
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Affiliation(s)
- James O. Armitage
- Department of Medicine; University of Nebraska Medical Center; Omaha Nebraska
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175
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Jiang L, Li SJ, Jiang YM, Long JX, Wang RS, Su J, Zhang Y. The significance of combining radiotherapy with chemotherapy for early stage extranodal natural killer/T-cell lymphoma, nasal type: a systematic review and meta-analysis. Leuk Lymphoma 2013; 55:1038-48. [PMID: 23885795 DOI: 10.3109/10428194.2013.827789] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Radiotherapy is regarded as a primary treatment for early stage extranodal natural killer (NK)/T-cell lymphoma, nasal type (ENKTL). However, whether combined modality treatment (CMT) comprising radiotherapy and chemotherapy is necessary remains controversial. A systematic review and meta-analysis of studies was performed to evaluate the significance of combining radiotherapy with chemotherapy for early stage ENKTL. Comparison of CMT and radiotherapy alone (RT) showed no significant difference by the measurement of complete response (CR) (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.73-1.58; p = 0.73), 5-year overall survival rate (OS) (HR 0.73; 95% CI 0.45-1.19; p = 0.21) and progression-free survival rate (PFS) (HR 0.76; 95% CI 0.50-1.17; p = 0.21). Additional chemotherapy did not decrease systemic failure (OR 1.52; 95% CI 0.97-2.40; p = 0.07), as well as locoregional failure (OR 0.94; 95% CI 0.52-1.73; p = 0.85). The results may support the assertion that the combination of radiotherapy with chemotherapy cannot improve treatment outcomes, but rather it increases adverse effects and financial costs. However, these results should be interpreted with caution.
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Affiliation(s)
- Li Jiang
- Department of Radiotherapy, The First Affiliated Hospital, Guangxi Medical University , Nanning , China
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Lin N, Song Y, Zheng W, Tu M, Xie Y, Wang X, Ping L, Ying Z, Zhang C, Deng L, Liu W, Zhu J. A prospective phase II study of L-asparaginase- CHOP plus radiation in newly diagnosed extranodal NK/T-cell lymphoma, nasal type. J Hematol Oncol 2013; 6:44. [PMID: 23816178 PMCID: PMC3734195 DOI: 10.1186/1756-8722-6-44] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/15/2013] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To explore the efficacy and safety of L-asparaginase in newly-diagnosed extranodal nature killer (NK)/T -cell lymphoma (ENKTL), we conducted a prospective phase II study of L-asparaginase, cyclophosphamide, vincristine, doxorubicin and dexamethasone (CHOP-L) regimen in combination with radiotherapy. PATIENTS AND METHODS Patients with newly diagnosed ENKTL and an ECOG performance status of 0 to 2 were eligible for enrollment. Treatment included 6-8 cycles of CHOP-L (cyclophosphamide, 750 mg/m(2) day 1; vincristine, 1.4 mg/m(2) day 1 (maximal dose 2 mg), doxorubicin 50 mg/m(2) day 1; dexamethasone 10 mg days 1-8; L-asparaginase 6000 u/m(2) days 2-8). Radiotherapy was scheduled after 4-6 cycles of CHOP-L regimen, depending on stage and primary anatomic site. The primary endpoint was complete response (CR) rate. RESULTS A total of 38 eligible patients were enrolled. The median age was 40.5 years (range, 15 to 71 years). Their clinical characteristics were male to female ratio, 24:14; Ann Arbor stage I, 20; II, 11; III, 3; IV, 4. CR and overall response rates were 81.6% (95% CI, 69.3% to 93.9%) and 84.2%, respectively. With a median follow-up of 25 months, the 2-year overall survival, progression-free survival and disease-free survival rates were 80.1% (95%CI, 73.3% to 86.9%), 81% (95%CI, 74.5% to 87.5%) and 93.6% (95%CI, 89.3% to 97.9%), respectively. The major adverse events were myelosuppression, liver dysfunction, and digestive tract toxicities. Grade 3 to 4 leukopenia and neutropenia were 76.3% and 84.2%, respectively. No treatment-related death was observed. CONCLUSION CHOP-L chemotherapy in combination with radiotherapy is a safe and highly effective treatment for newly diagnosed ENKTL.
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177
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Intensity-modulated radiotherapy versus three-dimensional conformal radiotherapy for stage I-II natural killer/T-cell lymphoma nasal type: dosimetric and clinical results. Radiat Oncol 2013; 8:152. [PMID: 23800149 PMCID: PMC3723914 DOI: 10.1186/1748-717x-8-152] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 06/01/2013] [Indexed: 12/25/2022] Open
Abstract
Background This study was to compare radiotherapy treatment planning and treatment outcomes following three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in stage I-II natural killer (NK)/T-cell lymphoma. Methods The cases of 94 patients with stage I-II NK/T-cell lymphoma, nasal type in the upper aerodigestive tract who treated between May 2005 and Dec 2008 were reviewed. These patients received radiotherapy with or without induction chemotherapy. Definitive radiotherapy was conducted using 3DCRT in 47 patients and IMRT in the other 47 patients with a regional field and a total dose of 50 Gy. Dosimetric pmeters of radiation treatment plans, local control probability (LCP), overall survival (OS), and toxicities were analyzed and compared between 3DCRT and IMRT. Results From the dosimetric analysis, IMRT demonstrated significantly better dose coverage and homogeneity than 3DCRT. However, after a median follow-up of 46 months, IMRT was not associated with improvements in 4y-OS (80.9% for 3DCRT vs. 82.7% for IMRT, p=0.87) or 4y-LCP (86.3% for 3DCRT vs. 88.9% for IMR p=0.85). Of the 18 patients who received cervical lymph node irradiation, those in the IMRT group received a lower mean parotid dose. Furthermore, at-risk organs were strictly kept within the safe dose range in both groups, and no severe late toxicity was observed. Conclusions IMRT provided better dose coverage than 3DCRT, although it failed to provide LCP and OS benefits. Definitive radiotherapy with a regional field and a total dose of 50 Gy is efficient and safe for NK/T-cell lymphoma using either IMRT or 3DCRT. However, IMRT may have the potential to reduce parotid gland hypofunction following cervical irradiation.
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178
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Abstract
Peripheral T-cell lymphomas (PTCLs) are a diverse family of lymphoid neoplasms with poor prognosis. They represent approximately 6-10% of non-Hodgkin lymphomas with significant geographic variation. The median age at diagnosis varies with histology, however the majority of patients with PTCL are in their fifth or sixth decade of life. Until recently clinical development of new agents for PTCL was slow due to difficulties in making the correct diagnosis, lack of uniform classification and combination of rarity and biologic diversity of the group. In the last 5 years, significant advances were made to overcome these obstacles, leading to the approval of three new agents for relapsed and refractory PTCL by the Food and Drug Administration, based on well conducted prospective studies. Pralatrexate, a unique antifol, was the first agent granted approval, followed by romidepsin, a histone deacetylase inhibitor, and brentuximab vedotin, an immunoconjugate. Owing to the unique nature of these agents, durable responses were seen in patients with highly refractory disease, and some of these responses are long lasting after discontinuation of therapy. Accumulating data indicate that these novel agents have little cumulative toxicity and can be administered continuously to patients who are not candidates for consolidative stem-cell transplantation (SCT), with little impact on quality of life. They might also provide a new salvage option for patients eligible for SCT with no impact on autologous stem-cell collection or subsequent engraftment. New studies are underway to evaluate efficacy and safety of new agents in combination regimens for both newly diagnosed and relapsed/refractory PTCL. Several other investigational drugs showed promise in recent trials. This review focuses on novel therapies for T-cell lymphomas, their place in current treatment paradigms and future directions.
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Affiliation(s)
- Andrei Shustov
- University of Washington Medical Center and Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Suite G3-200, Seattle, WA 98109, USA
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179
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Hatayama Y, Aoki M, Kawaguchi H, Narita Y, Hirose K, Sato M, Takai Y. Impact of dexamethasone, etoposide, ifosfamide and carboplatin as concurrent chemoradiotherapy agents for nasal natural killer/T-cell lymphoma. Mol Clin Oncol 2013; 1:680-684. [PMID: 24649228 PMCID: PMC3916130 DOI: 10.3892/mco.2013.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 04/23/2013] [Indexed: 11/28/2022] Open
Abstract
The nasal type of extranodal natural killer (NK)/T-cell lymphoma (NKTCL) is a rare aggressive lymphoma with poor prognosis. The reported 5-year overall survival for patients with localized nasal NKTCL treated with cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone (CHOP) is <50%. Dexamethasone, etoposide, ifosfamide and carboplatin (DeVIC) chemotherapy was designed as a salvage chemotherapeutic regimen for aggressive lymphoma, comprising multidrug resistance (MDR) non-related agents and etoposide, which is considered to be effective against nasal NKTCL. An experimental chemoradiotherapy (CRT) is currently being designed using DeVIC as the concurrent chemotherapeutic regimen for nasal NKTCL. The aim of this study was to examine the initial outcome of this treatment and evaluate its effectiveness and feasibility. Six patients (age range, 29–82 years; median age, 68 years) were treated with CRT using DeVIC between April, 2004 and February, 2010. The median follow-up was 56 months (range, 11–80 months). All patients were administered 3–6 cycles of full-dose DeVIC regimen. The chemotherapy was administered concurrently with radiotherapy (RT) and was repeated every 3 weeks. RT was performed using 4-MV X-ray and the prescription dose was 46–50 Gy/23–25 fx (median, 50 Gy). After treatment, all patients were followed up at our hospital. A complete remission was achieved in 5 patients (83%) at 1 month after treatment. The 5-year overall survival and disease-free survival rates were 100%. No severe adverse effect (grade ≥3) was reported. In conclusion, the initial results of the experimental CRT with DeVIC for this type of aggressive lymphoma were very encouraging. Further investigation is required on concurrent CRT with 50 Gy/25 fx and 3 cycles of DeVIC comprising non-MDR agents and etoposide for nasal NKTCL.
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Affiliation(s)
- Yoshiomi Hatayama
- Department of Radiology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Masahiko Aoki
- Department of Radiology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Hideo Kawaguchi
- Department of Radiology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Yuichiro Narita
- Department of Radiology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Katsumi Hirose
- Department of Radiology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Mariko Sato
- Department of Radiology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Yoshihiro Takai
- Department of Radiology, Hirosaki University School of Medicine, Hirosaki, Aomori 036-8562, Japan
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Moon SH, Cho SK, Kim WS, Kim SJ, Chan Ahn Y, Choe YS, Lee KH, Kim BT, Choi JY. The Role of 18F-FDG PET/CT for Initial Staging of Nasal Type Natural Killer/T-Cell Lymphoma: A Comparison with Conventional Staging Methods. J Nucl Med 2013; 54:1039-44. [DOI: 10.2967/jnumed.112.113399] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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181
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Abstract
Natural killer (NK)/T-cell lymphomas and NK-cell leukemias are aggressive malignancies. Occurring worldwide, they show a predilection for Asian and South American populations. Neoplastic cells are surface CD3-, cytoplasmic CD3ε+, CD56+, cytotoxic-molecule positive, Epstein-Barr virus (EBV) positive, with germline T-cell receptor gene. Lymphomas occur commonly in the nasal and upper aerodigestive region. Occasional cases present in the skin, salivary gland, testis, and gastrointestinal tract. Rare cases are disseminated with lymphadenopathy, hepatosplenomegaly, and a leukemic phase. Positron emission tomography computed tomography is useful in staging, as lymphomas are 18-fluorodeoxyglucose avid. Quantification of circulating EBV DNA is an accurate biomarker of tumor load. Nasal NK/T-cell lymphomas present mostly with stage I/II disease. Concomitant/sequential chemotherapy and radiotherapy is standard treatment. Radiotherapy alone is inadequate because of high systemic failure rate. For stage III/IV nasal, nonnasal, and disseminated lymphomas, systemic chemotherapy is indicated. Regimens containing l-asparaginase and drugs unaffected by P-glycoprotein are most effective. Hematopoietic stem cell transplantation (HSCT) is not indicated for early-stage nasal lymphomas. HSCT for lymphomas not in remission has poor results. In advanced-stage nasal, nonnasal, disseminated, or relapsed lymphomas, HSCT may be considered when remission is achieved. Prognostic modeling and EBV DNA monitoring may be useful in risk stratification for HSCT.
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182
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Kim JY, Lee SW, Lee JH, Suh C, Yoon DH, Lee BJ, Huh J, Choi EK, Kim JH, Song SY, Yoon SM, Kim YS, Kim SS, Park JH, Shin HS, Chang SK, Ahn SD. Stage IE/IIE extranodal NK/T-cell lymphoma arising in the nasal cavity: analysis of CT findings and their prognostic value. Clin Radiol 2013; 68:e384-90. [PMID: 23535315 DOI: 10.1016/j.crad.2012.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/08/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
AIM To investigate the computed tomography (CT) findings in patients with stage IE/IIE extranodal natural killer/T-cell lymphoma (ENKTL) arising in the nasal cavity and to evaluate whether imaging findings revealed by CT have prognostic value. MATERIALS AND METHODS The CT findings of 62 patients diagnosed with IE/IIE ENKTL arising in the nasal cavity were retrospectively reviewed. Imaging findings were investigated, and evaluated imaging findings were analysed for the prognostic value of overall survival (OS) and disease-free survival (DFS). RESULTS Of the 62 patients, 21 (34%) presented with a superficial infiltrative, 38 (61%) with a mass forming, and three (5%) with a combined pattern. Of all imaging findings, local invasiveness (n = 26, 42%), including bony destruction, erosion, or soft-tissue involvement, was the only independent prognostic factor for OS [p = 0.008; hazard ratio (HR): 3.85; 95% confidence intervals (CI): 1.42-10.44] and DFS (p = 0.001; HR: 4.25; 95% CI: 1.72-10.47). In a subgroup analysis of 36 cases with no local invasiveness, a superficial infiltrative pattern in one nasal cavity was a positive prognostic factor for OS (p = 0.028) and DFS (p = 0.008). CONCLUSION Imaging findings at CT provided clinically useful predictions for treatment outcomes. Local invasiveness revealed by CT findings was a strong prognostic factor for poor OS and DFS. In addition, in patients with no local invasiveness, a superficial infiltrative pattern in one nasal cavity predicted favourable OS and DFS.
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Affiliation(s)
- J Y Kim
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Asano N, Kato S, Nakamura S. Epstein–Barr virus-associated natural killer/T-cell lymphomas. Best Pract Res Clin Haematol 2013; 26:15-21. [DOI: 10.1016/j.beha.2013.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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184
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Zhang XM, Li YX, Wang WH, Jin J, Wang SL, Liu YP, Song YW, Fang H, Ren H, Zhou LQ, Liu XF, Yu ZH. Survival Advantage With the Addition of Radiation Therapy to Chemotherapy in Early Stage Peripheral T-Cell Lymphoma, Not Otherwise Specified. Int J Radiat Oncol Biol Phys 2013; 85:1051-6. [DOI: 10.1016/j.ijrobp.2012.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/09/2012] [Accepted: 08/10/2012] [Indexed: 11/28/2022]
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185
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Zhang XM, Li YX, Wang WH, Jin J, Wang SL, Liu YP, Song YW, Ren H, Fang H, Zhou LQ, Chen B, Qi SN, Liu QF, Lu NN, Liu XF, Yu ZH. Favorable outcome with doxorubicin-based chemotherapy and radiotherapy for adult patients with early stage primary systemic anaplastic large-cell lymphoma. Eur J Haematol 2013; 90:195-201. [PMID: 23301725 DOI: 10.1111/ejh.12060] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Xi-Mei Zhang
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Ye-Xiong Li
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Wei-Hu Wang
- 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
| | - Shu-Lian Wang
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Yue-Ping Liu
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Yong-Wen Song
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Hua Ren
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Hui Fang
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Li-Qiang Zhou
- Department of Medical Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Bo Chen
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Shu-Nan Qi
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Qing-Feng Liu
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Ning-Ning Lu
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Xin-Fan Liu
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
| | - Zi-Hao Yu
- Department of Radiation Oncology; Cancer Hospital; Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC); Beijing; China
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Abstract
The current World Health Organization (WHO) classification includes two types of natural killer (NK)-cell lymphomas: extranodal NK/T-cell lymphoma, nasal type (ENKL), and aggressive NK-cell leukemia (ANKL). These diseases are mostly endemic to East Asia and Latin America. The Epstein-Barr virus (EBV) is usually detected in tumor cells, suggesting that EBV plays an important role in lymphomagenesis. At the site of origin, ENKL can be divided into two major subtypes: nasal and extranasal diseases. The advanced disease presentation, highly aggressive clinical course, and poor prognosis of the latter are analogous to ANKL. It is well known that P-glycoprotein, which is a product of the multi-drug resistance (MDR1) gene, is expressed on neoplastic cells of ENKL or ANKL. This is a major cause of the refractoriness of malignant lymphoma to conventional chemotherapeutic regimens containing anthracycline. Recent studies, however, have identified that L-asparaginase-containing regimens, such as SMILE (steroid, methotrexate, ifosfamide, L-asparaginase and etoposide), are effective for ENKL. Considering the myelotoxicity of SMILE, its use in the treatment of ANKL needs some modifications, but this treatment scheme is promising in improving the prognosis of NK-cell lymphomas.
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Affiliation(s)
- Ritsuro Suzuki
- Department of HSCT Data Management & Biostatistics, Nagoya University, Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, 461-0047, Japan.
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187
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Abstract
Optimal treatment of non-Hodgkin lymphoma depends on establishing an accurate diagnosis and determining the stage or anatomic extent of the lymphoma. With this information, the treating clinician can assign the lymphoma to a subgroup characterized by expected natural history: indolent, aggressive, acute leukemia-like or viral, which generally reflects the typical behavior of the disease unmodified by treatment and indicates the urgency with which intervention must be offered. Finally, a number of special circumstances and problems posed by specific lymphomas must be anticipated and the therapeutic plan altered to accommodate them. After primary treatment, special secondary events such as transformation to more aggressive histologic types must be recognized and the treatment plan must be altered to address these events. This article reviews standard diagnostic grouping of lymphomas, special problems encountered during primary diagnosis and subsequent clinical evolution and emphasizes the cooperative interaction between the hematopathologist and the treating clinician that underlies optimal management.
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188
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Lee J, Cho SG, Chung SM, Ryu MR, Kim SH, Jang HS, Choi BO. Retrospective analysis of treatment outcomes for extranodal NK/T-cell lymphoma (ENKL), nasal type, stage I-IIE: single institute experience of combined modality treatment for early localized nasal extranodal NK/T-cell lymphoma (ENKL). Ann Hematol 2012. [PMID: 23180438 DOI: 10.1007/s00277-012-1630-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Extranodal natural killer/T-cell lymphoma (ENKL) is a very aggressive disease frequently involving the nasal cavity and upper aerodigestive tract. We retrospectively reviewed the treatment outcomes and treatment-associated complications of the patients with stage I-II early localized ENKL. A total of 24 patients were included. All patients were treated with combined chemoradiotherapy. Three, sixteen, and five patients were initially treated with radiation therapy, chemotherapy, and surgical procedures, respectively. Nine patients underwent hematopoietic stem cell transplantation (HSCT), and four patients administered immunotherapy with pegylated-interferon alpha. The mean observation time was 71.6 months (range, 29.7-183.6 months). Twenty patients achieved complete remission; thus, the overall response rate was 83.3 %. The 5-year overall survival (OS) and relapse-free survival (RFS) rates were 70.3 % and 62.2 %, respectively. In univariate analysis, HSCT was a significant prognostic indicator for OS and RFS. By combining HSCT, the 5-year OS and RFS rates were 100.0 % vs. 52.5 % (p = 0.018) and 88.9 % vs. 45.7 % (p = 0.045), respectively. Also, absence of B symptoms was a good prognostic factor for RFS, the 5-year RFS rate, 75.0 % vs. 25.0 % (p = 0.010), and B symptoms were significant for RFS in multivariate analysis (odds ratio = 7.4, confidence interval = 1.6~34.1, p = 0.011). However, a total of four cases of grade 3 toxicities were reported. Radiation dose range (≤4,500 vs. >4,500 cGy) was significantly correlated with late complications, as more severe complications occurred more frequently with a radiation dose >4,500 cGy (p = 0.026, in multivariate analysis). For more efficient treatment of ENKL, chemotherapy, HSCT, and/or immunotherapy can be combined with radiation therapy to prolong long-term survival and achieve good local control. Also, lower radiation dose could be administered to avoid severe late complications.
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Affiliation(s)
- Jayoung Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic Medical Center, College of Medicine, The Catholic University of Korea, 137-701, Banpo-dong, 505, Seocho-gu, Seoul, South Korea
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189
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Uri N, Schindler Y, Quitt M, Valkovsky O, Barzilai G. Primary NK/T-cell lymphoma of the larynx. EAR, NOSE & THROAT JOURNAL 2012; 91:206-7. [PMID: 22614556 DOI: 10.1177/014556131209100510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Laryngeal extranodal non-Hodgkin lymphoma is uncommon, accounting for less than 1% of all laryngeal neoplasms; the B-cell phenotype is predominant. Lymphomas outside the nasal cavity are rare and highly aggressive. We present a case of primary natural killer T-cell (NK/T-cell) lymphoma of the larynx that arose in a 45-year-old man. Because only a limited amount of data is available on laryngeal NK/T-cell lymphoma, the mainstay of treatment remains unclear, although some data suggest that radiotherapy alone is the best option. Our patient was treated with chemotherapy and radiotherapy, and he remained in remission 2 years later.
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Affiliation(s)
- Nechama Uri
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Technion-Israel Institute of Technology, Haifa, Israel.
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190
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Survival benefit with salvage radiotherapy for patients with locoregionally recurrent extranodal NK/T cell lymphoma, nasal type. Ann Hematol 2012; 92:325-32. [PMID: 23100164 DOI: 10.1007/s00277-012-1611-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022]
Abstract
The purposes of this study are to evaluate prognosis in patients with locoregionally recurrent extranodal nasal-type NK/T cell lymphoma (NKTCL) and to determine the value of salvage radiotherapy. Forty-two patients with NKTCL who developed first locoregional recurrence with (n = 13) or without (n = 29) systemic failure were reviewed. Retreatment included chemotherapy (n = 20), radiotherapy (n = 13), and radiotherapy plus chemotherapy (n = 9). Fifteen patients were reirradiated for localized recurrent disease. The 5-year overall survival (OS) rate after recurrence was 40 %, with a median survival of 26 months. The 2-year OS rate and median OS were 68 % and 36 months for locoregional recurrence only, compared with 31 % and 14 months for both locoregional and systemic recurrence, respectively (p = 0.034). Subgroup analysis for patients with localized recurrent disease revealed an improved OS with radiotherapy. The 2-year and 5-year OS rates were 77 and 69 % for radiotherapy, respectively, compared with a 2-year OS rate of 50 % and median OS of 16 months for chemotherapy alone (p = 0.006). Patients with localized recurrence had a better prognosis than those with systemic recurrence. Salvage radiotherapy or reirradiation resulted in a favorable prognosis for patients with localized recurrent disease.
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191
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Current and future management of NK/T-cell lymphoma based on clinical trials. Int J Hematol 2012; 96:562-71. [DOI: 10.1007/s12185-012-1189-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 09/22/2012] [Accepted: 09/24/2012] [Indexed: 11/26/2022]
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192
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Song MK, Chung JS, Shin HJ, Moon JH, Ahn JS, Lee HS, Lee SM, Lee GW, Kim SJ, Lee SM. Clinical value of metabolic tumor volume by PET/CT in extranodal natural killer/T cell lymphoma. Leuk Res 2012; 37:58-63. [PMID: 23040533 DOI: 10.1016/j.leukres.2012.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 08/22/2012] [Accepted: 09/16/2012] [Indexed: 10/27/2022]
Abstract
This study investigated whether metabolic tumor volume (MTV) by PET/CT as indicator of extent of lymphoma burden would be a prognostic factor in stage I(E)/II(E) extranodal natural killer/T cell lymphoma (ENKTCL). Eighty patients with stage I(E)/II(E) ENKTCL in the upper aerodigestive tract underwent PET/CT at diagnosis were enrolled and 32 patients received upfront radiotherapy (RTx). MTV was measured on PET/CT images by the extranodal region above SUV, 2.5. Receiver operating curve analyses indicated that an MTV of 35.2 cm(3) was the ideal cut-off to distinguish between low and high MTV groups. Clinical outcomes were compared according to several prognostic factors (age, stage, high performance status [PS], high International Prognostic Index, elevated lactate dehydrogenase [LDH], local tumor invasiveness [LTI], high MTV and up-front RT). High PS, elevated LDH, LTI, high MTV and upfront RT were associated with survivals. In multivariate analysis, high MTV (PFS, HR=4.170, 95% CI=1.714-10.147, p=0.002; OS, HR=4.102, 95% CI=1.617-10.408, p=0.003) and up-front RT (PFS, HR=0.410, 95%CI=0.178-0.946, p=0.037; OS, HR=0.365, 95% CI=0.152-0.872, p=0.023) were significant independent prognostic factors. Upfront RTx and extent of tumor burden, as measured by the MTV, had significant prognostic value in patients with ENKTCL.
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Affiliation(s)
- Moo-Kon Song
- Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Republic of Korea.
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193
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Hopfinger G, Griessl R, Sifft E, Taylor N, Kenner L, Greil R, Merkel O. Novel treatment avenues for peripheral T-cell lymphomas. Expert Opin Drug Discov 2012; 7:1149-63. [PMID: 22998641 DOI: 10.1517/17460441.2012.727392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Peripheral T-cell lymphomas (PTCLs) and natural killer (NK) or T-cell non-Hodgkin's lymphomas (NHLs) are a rare and heterogeneous class of diseases with generally poor prognosis. This work intends to provide a focused primer on clinical diagnosis, current treatment regimens, and novel therapeutic approaches. The recent WHO classification has defined 18 different subtypes of PTCL and NK T-cell lymphomas. Diagnosis is mainly based on histology, flow-cytometric analysis of surface molecules in the blood and bone marrow, cytogenetics/fluorescence in situ hybridization (FISH), and T-cell receptor (TCR) rearrangement. Staging as well as follow-up diagnostic procedures rely on imaging techniques such as computerized tomography (CT) and positron emission tomography (PET). Current chemotherapeutic regimens such as CHOP result in a 60 - 70% response rate; however, 5-year survival is only around 30%. Therefore, new treatment strategies are urgently needed. Currently, different drug classes are under scrutiny. AREAS COVERED The authors discuss substances that directly target the tumor cells. The article includes such substances as antimetabolites, antibodies, histone deacetylase inhibitors, tyrosine kinase inhibitors, and immunomodulatory substances such as lenalidomide. EXPERT OPINION In the future a close collaboration of geneticists, biochemists, and clinicians together with new technologies such as deep sequencing will allow the refinement of treatment strategies in many diseases including PTCLs and NHLs. This refinement will allow treatments to be prepared according to the need of the individual patient.
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Affiliation(s)
- Georg Hopfinger
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology of the Paracelsus Private Medical University, Laboratory for Immunological and Molecular Cancer Research, Müllner Hauptstrasse 48, 5020 Salzburg, Austria.
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194
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Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) in the treatment of stage IE/IIE extranodal natural killer/T cell lymphoma, nasal type: 13-year follow-up in 135 patients. Int J Hematol 2012; 96:617-23. [PMID: 22983648 DOI: 10.1007/s12185-012-1174-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 09/04/2012] [Accepted: 09/04/2012] [Indexed: 01/12/2023]
Abstract
We conducted a retrospective study of 135 patients of stage IE/IIE extranodal natural killer/T cell lymphoma, nasal type (ENKTL) treated with CHOP as induction chemotherapy to find some valuable prognostic factors and analyze the usefulness of International Prognostic Index (IPI) and Korean Prognostic Index (KPI) in predicting prognosis. Most of the patients were in the low-risk group (IPI score 0-1). Complete remission (CR) after induction chemotherapy was achieved in 31.8 % of the patients, which increased to 69.6 % after radiotherapy. The 2-, 5-, and 10-year overall survival (OS) rates were 60, 48, and 43 %, respectively. Patients with better performance status (ECOG 0-1), normal serum LDH level, without local invasiveness, low KPI scores, and IPI score of 0 had significantly better overall survival (P < 0.05) in univariate analysis. Using multivariate analysis, we identified serum LDH level, ECOG PS score and local invasiveness to be independent prognostic factors. In conclusion, ENKTL is an aggressive lymphoma that shows heterogeneity. The IPI and KPI score systems should be improved further to classify patients into different groups, and should be validated in larger prospective trials. Due to the multi-drug resistance mechanism of ENKTL, CHOP is no longer the state of art and novel drugs should be incorporated into future treatments.
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195
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Clinical implications of plasma Epstein-Barr virus DNA in early-stage extranodal nasal-type NK/T-cell lymphoma patients receiving primary radiotherapy. Blood 2012; 120:2003-10. [DOI: 10.1182/blood-2012-06-435024] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The clinical value of plasma Epstein-Barr virus (EBV) DNA has not been evaluated in patients with early-stage extranodal nasal-type NK/T-cell lymphoma (NKTCL) receiving primary radiotherapy. Fifty-eight patients with stage I disease and 11 with stage II disease were recruited. High pretreatment EBV-DNA concentrations were associated with B-symptoms, elevated lactate dehydrogenase levels, and a high International Prognostic Index score. EBV-DNA levels significantly decreased after treatment. The 3-year overall survival (OS) rate was 82.6% for all patients. Stage I or II patients with a pretreatment EBV-DNA level of ≤ 500 copies/mL had 3-year OS and progression-free survival (PFS) rates of 97.1% and 79.0%, respectively, compared with 66.3% (P = .002) and 52.2% (P = .045) in patients with EBV-DNA levels of > 500 copies/mL. The 3-year OS and PFS rates for patients with undetectable EBV-DNA after treatment was significantly higher than patients with detectable EBV-DNA (OS, 92.0% vs 69.8%, P = .031; PFS, 77.5% vs 50.7%, P = .028). Similar results were observed in stage I patients. EBV-DNA levels correlate with tumor load and a poorer prognosis in early-stage NKTCL. The circulating EBV-DNA level could serve both as a valuable biomarker of tumor load for the accurate classification of early-stage NKTCL and as a prognostic factor.
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196
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Law LY. Dramatic response to trastuzumab and paclitaxel in a patient with human epidermal growth factor receptor 2-positive metastatic cholangiocarcinoma. J Clin Oncol 2012; 30:e271-3. [PMID: 22851567 DOI: 10.1200/jco.2012.42.3061] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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197
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Wang L, Wang ZH, Chen XQ, Li YJ, Wang KF, Xia YF, Xia ZJ. First-line combination of gemcitabine, oxaliplatin, and L-asparaginase (GELOX) followed by involved-field radiation therapy for patients with stage IE/IIE extranodal natural killer/T-cell lymphoma. Cancer 2012; 119:348-55. [DOI: 10.1002/cncr.27752] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 06/14/2012] [Accepted: 06/25/2012] [Indexed: 01/08/2023]
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198
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Hawkes EA, Wotherspoon A, Cunningham D. Diagnosis and management of rare gastrointestinal lymphomas. Leuk Lymphoma 2012; 53:2341-50. [PMID: 22616672 DOI: 10.3109/10428194.2012.695780] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Primary gastrointestinal (GI) lymphoma is rare, however accounts for 30-40% of cases of extranodal lymphoma. Several lymphoma subtypes have a propensity for GI tract involvement. Whilst the literature is dominated by data related to the more common extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) and diffuse large B-cell lymphoma (DLBCL) of the stomach, this review focuses on the rare subtypes of enteropathy-associated T-cell lymphoma (EATL), GI follicular lymphoma, mantle cell lymphoma (lymphomatous polyposis coli) and extranodal natural killer (NK)/T-cell lymphoma nasal-type (ENKTL). Due to its rarity, the majority of data regarding primary GI lymphoma have been derived from subgroups of larger cohorts. Clinical characteristics, prognosis and management can differ from those of nodal disease, despite corresponding histology. We discuss these differences and the challenges associated with diagnosis and management of these rare diseases.
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199
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Li JZ, Tao J, Ruan DY, Yang YD, Zhan YS, Wang X, Chen Y, Kuang SC, Shao CK, Wu B. Primary duodenal NK/T-cell lymphoma with massive bleeding: A case report. World J Clin Oncol 2012; 3:92-7. [PMID: 22724088 PMCID: PMC3380103 DOI: 10.5306/wjco.v3.i6.92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/12/2012] [Accepted: 06/05/2012] [Indexed: 02/06/2023] Open
Abstract
Primary natural killer/T-cell (NK/T-cell) lymphoma of the gastrointestinal tract is a very rare disease with a poor prognosis, and the duodenum is quite extraordinary as a primary lesion site. Here, we describe a unique case of a primary duodenal NK/T-cell lymphoma in a 26-year-old man who presented with abdominal pain and weight loss. Abdominal computed tomography scan demonstrated a hypodense tumor in the duodenum. Because of massive upper gastrointestinal tract bleeding during hospitalization, the patient was examined by emergency upper gastrointestinal endoscopy. Under endoscopy, an irregular ulcer with mucosal edema, destruction, necrosis, a hyperplastic nodule and active bleeding was observed on the duodenal posterior wall. Following endoscopic hemostasis, a biopsy was obtained for pathological evaluation. The lesion was subsequently confirmed to be a duodenal NK/T-cell lymphoma. The presenting symptoms of primary duodenal NK-/T-cell lymphoma in this patient were abdominal pain and gastrointestinal bleeding, and endoscopy was important for diagnosis. Despite aggressive treatments, the prognosis was very poor.
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Affiliation(s)
- Jian-Zhong Li
- Jian-Zhong Li, Jin Tao, Yi-Dong Yang, Ya-Shi Zhan, Xing Wang, Yu Chen, Bin Wu, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
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Chauchet A, Michallet AS, Berger F, Bedgedjian I, Deconinck E, Sebban C, Antal D, Orfeuvre H, Corront B, Petrella T, Hacini M, Bouteloup M, Salles G, Coiffier B. Complete remission after first-line radio-chemotherapy as predictor of survival in extranodal NK/T cell lymphoma. J Hematol Oncol 2012; 5:27. [PMID: 22682004 PMCID: PMC3416641 DOI: 10.1186/1756-8722-5-27] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 06/08/2012] [Indexed: 01/06/2023] Open
Abstract
Background Extranodal nasal-type NK/T-cell lymphoma is a rare and severe disease. Considering the rarity of this lymphoma in Europe, we conducted a multicentric retrospective study on nasal-type NK/T cell lymphoma to determine the optimal induction strategy and identify prognostic factors. Methods Thirty-six adult patients with nasal-type NK/T-cell lymphoma were recruited and assessed. In total, 80 % of patients were classified as having upper aerodigestive tract NK/T-cell lymphoma (UNKTL) and 20 % extra-upper aerodigestive tract NK/T-cell lymphoma (EUNKTL). Results For advanced-stage disease, chemotherapy alone (CT) was the primary treatment (84 % vs. 10 % for combined CT + radiation therapy (RT), respectively), while for early-stage disease, 50 % of patients received the combination of CT + RT and 50 % CT alone. Five-year overall survival (OS) and progression-free survival (PFS) rates were 39 % and 33 %. Complete remission (CR) rates were significantly higher when using CT + RT (90 %) versus CT alone (33 %) (p < 0.0001). For early-stage disease, CR rates were 37 % for CT alone versus 100 % for CT + RT. Quality of response was significantly associated with survival, with 5-year OS being 80 % for CR patients versus 0 % for progressive disease patients (p < 0.01). Conclusion Early RT concomitantly or sequentially with CT led to improved patient outcomes, with quality of initial response being the most important prognosticator for 5-year OS.
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Affiliation(s)
- Adrien Chauchet
- Department of Hematology, Centre Hospitalier universitaire Lyon Sud, Pierre Benite, France
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