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Pan S, Mohamed N, Saad S, Parekh P. Extranodal Natural Killer/T-cell Lymphoma Isolated to the Leg: A Case Report. Cureus 2023; 15:e40011. [PMID: 37425545 PMCID: PMC10322670 DOI: 10.7759/cureus.40011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Extranodal natural killer/T-cell lymphoma (ENKTL) is a subtype of non-Hodgkin's lymphoma, and it is exceedingly rare in North America. The "extranasal" subtype of ENKTL frequently involves the skin and typically has an aggressive course with no current standard of treatment available. In this report, we present a case of cutaneous ENKTL in an otherwise healthy middle-aged male.
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Affiliation(s)
- Sharon Pan
- Dermatology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Nada Mohamed
- Pathology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Saadeddine Saad
- Dermatology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Palak Parekh
- Dermatology, Baylor Scott & White Medical Center - Temple, Temple, USA
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High-dose extended-field radiotherapy plus chemotherapy improved survival in extranodal NK/T-cell lymphoma in a real-life setting: results from the multicenter T-Cell Brazil Project. Sci Rep 2022; 12:20557. [PMID: 36446856 PMCID: PMC9709053 DOI: 10.1038/s41598-022-25034-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022] Open
Abstract
Extranodal natural-killer/T-cell lymphoma (ENKTL) is a rare and aggressive Epstein-Barr virus related mature T-cell and natural-killer malignancy. Although highly prevalent in South America, few studies covering data from this geographic location have been published. Therefore, this study aims to report clinical characteristics, prognostic factors, and outcomes in a multicenter cohort of ENKTL patients from Brazil. This retrospective, observational and multicenter study included 98 ENKTL patients treated during two decades in Brazil. Data were extracted from the T-Cell Brazil Project database. In our cohort, 59/98 patients (60.2%) were male, with a median age of 50 years. Sixty-two patients (63.3%) had B-symptoms, 26/98 (26.5%) had Eastern Cooperative Oncology Group scale ≥ 2; 16/98 (16.3%) presented extranasal disease and 34.7% (34/98) were advanced-stage (Ann Arbor/Cotswolds III/IV). The median follow-up for the whole cohort was 49 months, with an estimated 2-year overall survival (OS) and progression-free survival (PFS) of 51.1% and 17.7%, respectively. In early-stage disease (IE/IIE), the median OS was 21.8 months for patients treated with concurrent radiotherapy plus chemotherapy (CCRT-VIPD [etoposide/vp-16, ifosfamide, cisplatin and dexamethasone), 16.2 months for sequential chemoradiotherapy (SCRT) followed by asparaginase-based regimens, and 56.7 months for SCRT followed by CHOP-like (cyclophosphamide, doxorrubicin, vincristine and prednisone) treatments, p = 0.211. CCRT was associated with higher rates of early-mortality, hematological toxicity, and mucositis. Median OS was 8.2 months for patients with advanced-stage disease receiving regimens containing asparaginase compared to 3.2 months for anthracycline-based therapy, p = 0.851. Chemo-radiotherapy (CRT) regimens demonstrated better OS (p = 0.001) and PFS (p = 0.007) than chemotherapy alone. Multivariate analysis revealed anemia, relapsed/refractory (R/R) disease and radiotherapy omission as poor outcome predictors for OS. Lymphopenia and radiotherapy omission adversely affected PFS. Concerning progression of disease within 24-months (POD-24), clinical stage III/IV was a poor outcome predictor. In this real-life Brazilian cohort, ENKTL presented dismal outcomes. Radiation therapy was an independent factor for increased OS and PFS, but CCRT regimens were associated with higher toxicities. Polychemotherapy based on anti-multi drug resistant agents was not associated with survival benefit in either early or advanced-stage disease in our patient cohort.
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Jain R, Bhandari S, Prakash G, Hage N. The relevance of extra-nodal natural killer/T-cell lymphoma to the oral health care providers- A clinical review with case report. J Oral Biol Craniofac Res 2021; 11:502-506. [PMID: 34354908 DOI: 10.1016/j.jobcr.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/10/2021] [Indexed: 11/18/2022] Open
Abstract
Lymphomas are the second most common malignancy in the oral cavity after squamous cell carcinoma. Non-specific clinical presentation of lymphoma mimics the other common oral pathologies thereby; delaying its diagnosis, ensuing definitive treatment, and leading to a guarded prognosis. The present clinical review and accompanying case report highlights the clinical presentation, diagnostic challenges, progression, manifestations, and holistic management of a rare extra-nodal, nasal variant of Natural Killer T-cell lymphoma and underscores the importance of interdisciplinary coordination in the overall management of this aggressive tumor.
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Affiliation(s)
- Radhika Jain
- Unit of Prosthodontics, Oral Health Sciences Centre, PGIMER, Chandigarh, India
| | - Sudhir Bhandari
- Unit of Prosthodontics, Oral Health Sciences Centre, PGIMER, Chandigarh, India
| | - Gaurav Prakash
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Neemu Hage
- Department of Otorhinolaryngology, PGIMER, Chandigarh, India
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Bothra SJ, Bhandari P, Agrawal N, Tejwani N, Ahmed R, Khushoo V, Mirgh S, Bhurani D. Extranodal NK-T Cell Lymphoma, Nasal Type: Retrospective Analysis of Real-World Data. Indian J Hematol Blood Transfus 2019; 36:260-266. [PMID: 32425375 DOI: 10.1007/s12288-019-01195-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
Peripheral T cell lymphomas constitute nearly 15% of all cases on non-Hodgkin lymphoma. Of these, NK-T cell lymphoma nasal type is a rare and aggressive form. We present our experience of 16 patients of NK/T cell lymphoma which constituted approximately 1% of all lymphoma (N = 1590) cases treated at our center. Male to female ratio was 4.3:1. Median age of presentation was 42 years. Early Stage patients (n = 11) were treated with DeVIC regimen (n = 10) and SMILE (n = 1) chemotherapy and RT to all the patients. Advanced stage patients were treated with SMILE regimen (n = 4) and ICE and local RT (n = 1) with one treatment related mortality. The presence of B-symptoms adversely affected survival. The estimated median PFS and OS were 39 and 49 months respectively. Overall survival was not reached in Limited Stage patients (stage 1 and 2) and 8 months in patients with advanced stage (stage IV) (p = 0.001). According to the new CSWOG staging (retrospectively applied), comparing the Limited versus Extensive Stage, the earlier group has a significantly better estimated PFS (p = 0.020) and OS (p = 0.007). ENKTL is a rare malignancy with aggressive course. B-symptoms portend a poor prognosis to patients with this aggressive lymphoma. The new staging system helps estimate survival better.
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Affiliation(s)
- Sneha J Bothra
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Pragya Bhandari
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Narendra Agrawal
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Narender Tejwani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Rayaz Ahmed
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Vishvdeep Khushoo
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Sumeet Mirgh
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Dinesh Bhurani
- Department of Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
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Chang Y, Fu XR, Cui M, Li WM, Zhang L, Li X, Li L, Sun ZC, Zhang XD, Li ZM, You XY, Nan FF, Wu JJ, Wang XH, Zhang MZ. Activated hippo signal pathway inhibits cell proliferation and promotes apoptosis in NK/T cell lymphoma cells. Cancer Med 2019; 8:3892-3904. [PMID: 31124291 PMCID: PMC6639190 DOI: 10.1002/cam4.2174] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/15/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background Natural Killer T–Cell Lymphoma (NKTCL) is a subtype of Non‐Hodgkin's Lymphoma, and its morbidity is ranked the first of T‐Cell Lymphoma. Hippo signaling pathway is involved in the pathogenesis of tumors. However, the role of Hippo signaling pathway in the oncogenesis of NKTCL still remains unclear. Methods The expressions of mammalian sterile 20‐like kinase 1 (MST1) and Yes‐associated protein (YAP) were investigated by RT‐PCR and Western blotting. Cell viability was detected by MTT assays. Cell cycle and cell apoptosis were determined by flow cytometry. Cell proliferative capacity was detected by colony formation assay. Nude mice xenograft models were established and the tumor sections were analyzed by immunohistochemistry (IHC) staining. Results The expression of MST1 was significantly down‐regulated in NKTCL tissues (n = 30) and cell lines, while the expression of YAP was significantly up‐regulated, and the phosphorylation of YAP was inhibited. Overexpression of MST1, knockdown of YAP, or verteporfin (VP) treatment could inhibit cell proliferation, and promote cell cycle arrest and apoptosis in NKTCL cells, while knockdown of MST1 and overexpression of YAP promoted cell proliferation. Additionally, Bcl‐2/Bax ratio and downstream effectors of Hippo signaling pathway (c‐myc, survivin, cyclinD1, CTGF, and TEAD) were significantly decreased when MST1 was overexpressed and YAP was knocked down or after VP treatment. Furthermore, our mice model demonstrated that activation of Hippo signal pathway suppressed the tumorigenesis of NKTCL. Conclusion The activation of Hippo signal pathway via overexpressing MST1 or down‐regulating YAP can inhibit the tumorigenesis of NKTCL.
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Affiliation(s)
- Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-Rui Fu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Cui
- Department of Head & Neck and Thyroid, The Cancer Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Wei-Ming Li
- Department of Oncology, Henan University of Chinese Medicine, Zhengzhou, China
| | - Lei Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen-Chang Sun
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xu-Dong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhao-Ming Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao-Yan You
- Department of Obstetrics and Gynecology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Fei-Fei Nan
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing-Jing Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Hua Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming-Zhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Zhu L, Zhang X, Fu X, Li Z, Sun Z, Wu J, Wang X, Wang F, Li X, Niu S, Ding M, Yang Z, Yang W, Yin M, Zhang L, Zhang M. c‐Myc mediated upregulation of long noncoding RNA SNHG12 regulates proliferation and drug sensitivity in natural killer/T‐cell lymphoma. J Cell Biochem 2019; 120:12628-12637. [PMID: 30825244 DOI: 10.1002/jcb.28529] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/29/2018] [Accepted: 01/09/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Linan Zhu
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Xudong Zhang
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Xiaorui Fu
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Zhaoming Li
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Zhenchang Sun
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Jingjing Wu
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Xinhua Wang
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Feng Wang
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Xiangke Li
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Songtao Niu
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Mengjie Ding
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Zhenzhen Yang
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Wanqiu Yang
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Meifeng Yin
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Lei Zhang
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
| | - Mingzhi Zhang
- Department of Oncology The First Affiliated Hospital of Zhengzhou University Zhengzhou People’s Republic of China
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Pokrovsky VS, Vinnikov D. L-Asparaginase for newly diagnosed extra-nodal NK/T-cell lymphoma: systematic review and meta-analysis. Expert Rev Anticancer Ther 2017. [PMID: 28621166 DOI: 10.1080/14737140.2017.1344100] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this review was to compare the efficacy of asparaginase (ASP)-containing vs ASP-absent regimens in the first-line treatment of ENKTL patients. METHODS The PRISMA protocol was used to search PubMed and Embase for both controlled and uncontrolled studies of ASP or alternative chemotherapy (CT) for newly diagnosed ENKTL, published in English by March 2017. The regimens were compared to calculate relative risk (RR) with 95% confidence interval (CI) of the overall response rate (ORR), complete response (CR) or partial response (PR). RESULTS Out of 38 studies included, eight were controlled trials, with the pooled RR of ORR in stage I-II 1.54 (95% CI 1.34-1.77); stage I-IV 1.34 (95% CI 1.09-1.64). In stage III-IV CT combined with radiotherapy (RT), RR of ORR was 2.30 (95% CI 1.66-3.18). ASP was also superior in achieving CR. When all single arms combined, RR of ORR after CT with ASP was 1.52 (95% CI 1.38-1.67) in stage I-II (15 studies); 1.44 (95% CI 1.32-1.57) in all stages (29 studies); 1.31 (95% CI 1.24-1.38) and 1.66 (95% CI 1.18-2.34) in stages I-II and III-IV combined with RT, correspondingly. CONCLUSIONS ASP-based CT significantly improved ORR and CR in patients with newly diagnosed both early-stage and advanced-stage ENKTL.
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Affiliation(s)
- Vadim S Pokrovsky
- a Department of Combined Therapy , N.N. Blokhin Cancer Research Center , Moscow , Russian Federation.,b Medical Faculty , Peoples' Friendship University of Russia (RUDN University) , Moscow , Russian Federation
| | - Denis Vinnikov
- c School of Public Health , Al-Farabi Kazakh National University , Almaty , Kazakhstan.,d Biological Institute , National Research Tomsk State University , Tomsk , Russian Federation
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Concurrent Etoposide, Steroid, High-dose Ara-C and Platinum chemotherapy with radiation therapy in localised extranodal natural killer (NK)/T-cell lymphoma, nasal type. Eur J Cancer 2015; 51:2386-95. [PMID: 26254810 DOI: 10.1016/j.ejca.2015.07.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Radiation combined with chemotherapy has recently been proposed to treat patients with localised extranodal natural killer (NK)/T lymphoma (ENKTL), nasal type. However, the modalities of the chemoradiotherapy combination and drug choices remain a matter of debate. We conducted a concurrent chemoradiotherapy (CCRT) study with the ESHAP (Etoposide, Steroid, High-dose Ara-C and Platinum) regimen. METHODS An induction phase with two upfront courses of CCRT delivering a 40Gy dose of radiation concurrently with two cycles of the ESHAP chemotherapy regimen, followed by a consolidation phase with 2-3 cycles of ESHAP chemotherapy alone. RESULTS Thirteen patients with localised ENKTL nasal type were enrolled between January 2005 and December 2014. The median age was 62years. Ten and three patients had Ann Arbor stage IE and IIE disease, respectively. They all completed the induction CCRT phase. A median of two consolidation ESHAP cycles were delivered. During consolidation, 8/13 (62%) patients had a reduction in the number of chemotherapy cycles or reduced chemotherapy doses, due to haematologically adverse events. The other five patients (38%) received the full number of ESHAP cycles of chemotherapy scheduled without a dose reduction. All but one patient (92%) experienced grade 3-4 haematological toxicity. The main non-haematological grade 3-4 toxicity was mucositis in 6/13 (46%) patients. All but one patient (92%) achieved a complete remission. Two-year overall survival was 72%. CONCLUSIONS With optimal management of the specific toxicities induced by this treatment modality, CCRT with the ESHAP regimen yielded high efficacy against localised ENKTL, nasal type.
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