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Combined therapy in untreated patients improves outcome in Nasal NK/T lymphoma: results of a clinical trial

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Abstract

Nasal NK/T-cell lymphoma is a rare presentation of T-cell lymphoma in USA and in Europe, but is the most common presentation in Latin America. The lymphoma is associated with a worse prognosis even in the early stage. Until now, a better treatment has not been determined. We performed a prospective, open-label, controlled clinical trial to assess the efficacy and toxicity of the most common treatment options. We treated 427 patients, of whom 109 patients received radiotherapy (RT), 116 patients received chemotherapy (C), and 202 patients received combined therapy (CT), which were balanced according to stage and prognostic factors. Complete response was achieved in 91 % (95 % confidence interval CI 88–102 %) in CT arm 69 % (95 % CI 61–75 %) in RT arm; and 59 % (95 % CI 48–64 %) in C arm (p < 0.01). A progression-free disease was 91 % (95 % CI 83–96 %); 78 % (95 % CI 69–86 %); and 40 % (95 % CI 32–46 %), respectively (p < 0.01). Actuarial curves of overall survival at 5 years were as follows: 86 % (95 % CI 81–90 %), for CT; 64 % (95 % CI 59–70 %) for RT; and 45 % (95 % CI 39–51 %) for C (p < 0.001). Toxicity was mild and well tolerated. To our knowledge, this is the first controlled clinical trial, with a large number of patients and longer follow-up. Thus, we conclude that CT is the best therapeutic option in this setting of patients.

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References

  1. Ushimi K. Progress, understanding and management of natural killer-cell malignancies. Br J Haematol. 2007;139:532–44.

    Article  Google Scholar 

  2. Kohrt H, Advani R. Extranodal natural killer/T-cell lymphoma. Leuk Lymphoma. 2009;50:1773–84.

    Article  PubMed  CAS  Google Scholar 

  3. Avilés A, Rodriguez L, Guzmán R, et al. Angiocentric T-cell lymphoma of the nose, paranasal sinuses and hard palate. Hematol Oncol. 1992;10:141–4.

    Article  PubMed  Google Scholar 

  4. Avilés A, Díaz N, Neri N, Cleto S, Talavera A. Angiocentric nasal T/natural killer cell lymphoma. A single centre study of prognostic factors in 108 patients. Clin Lab Haematol. 2000;22:215–20.

    Article  PubMed  Google Scholar 

  5. Li YX, Luang H, Feng XL, et al. Immunophenotypic characteristics and clinical relevance of CD56+ and CD56−, extranodal nasal-type natural killer/T-cell lymphoma. Leuk Lymphoma. 2011;52:417–24.

    Article  PubMed  CAS  Google Scholar 

  6. Ai W, Chang ET, Fish K, Fu K, Weisenburguer SS, Keegan THM. Racial patterns of extranodal natural killer/T-cell lymphoma, nasal type in California. Br J Haematol. 2012;156:626–32.

    Article  PubMed  CAS  Google Scholar 

  7. Li YX, Liu QF, Fang H, et al. Variable clinical presentations of nasal and Waldeyer ring natural killer/T-cell lymphoma. Clin Cancer Res. 2009;15:2905–12.

    Article  PubMed  Google Scholar 

  8. Kim GE, Cho JH, Yang WO et al. Angiocentric lymphoma of head and neck: Patterns of systemic failure after radiation therapy. J Clin Oncol. 2006;244–63.

  9. Li YX, Liu GF, Wang HW, et al. Failure patterns and clinical implications in early stage nasal natural killer/T-cell lymphoma treated with primary radiotherapy. Cancer. 2011;117:5203–11.

    Article  PubMed  Google Scholar 

  10. Lee J, Suh C, Park YH, et al. Extranodal natural killer/T-cell lymphoma, nasal type: prognostic model from an retrospective multicenter study. J Clin Oncol. 2006;24:612–8.

    Article  PubMed  Google Scholar 

  11. Suzuki R, Suzumiya J, Yamaguchi M, et al. Prognostic factors for nature natural killer (NK) cell neoplasms: aggressive NK-cell leukemia and extranodal NK-cell lymphoma, nasal type. Ann Oncol. 2010;21:1032–40.

    Article  PubMed  CAS  Google Scholar 

  12. Wang ZY, Li YX, Wang H, et al. Unfavourable prognosis of elderly patients with early-stage extranodal nasal-type NK/T-cell lymphoma. Ann Oncol. 2011;22:390–6.

    Article  PubMed  CAS  Google Scholar 

  13. Wang ZY, Li XY, Wang WH, et al. Primary radiotherapy showed favorable outcome in treating extra nodal nasal-type NK/T-cell lymphoma in children and adolescents. Blood. 2009;114:4771–6.

    Article  PubMed  CAS  Google Scholar 

  14. Yoo JY, Chi KH, Ymg MH, et al. Radiation therapy versus chemotherapy as initial treatment for localized nasal natural killer/T-cell lymphoma. Ann Oncol. 2004;15:618–25.

    Article  Google Scholar 

  15. Chim CS, Ma SY, Au YA, et al. Primary natural killer cell lymphoma. Long term treatment outcome and relationship with the International Prognostic Index. Blood. 2004;103:212–24.

    Google Scholar 

  16. Shikama N, Uceda H, Nakamura S, et al. Localize aggressive non-Hodgkin’s lymphoma of the nasal cavity. Int J Radiat Oncol Biol Phys. 2001;51:1228–33.

    Article  PubMed  CAS  Google Scholar 

  17. Cheong MM, Chan JKC, Lau WN, et al. Early stage nasal NK/T-cell lymphoma. Clinical outcome, prognostic factors and the effect of treatment modality. Int J Radiat Oncol Biol Phys. 2002;54:182–90.

    Article  Google Scholar 

  18. MacDonald SL, Mulroy L, Wilke DR, Burrel S. PET/CT aids the staging of and radiotherapy planning for early –stage extranodal natural killer/T-cell lymphoma, nasal type. Radiat Oncol. 2011;6:182.

    Article  PubMed  CAS  Google Scholar 

  19. Wang H, Li YX, Wang WH, et al. Mild toxicity and favorable prognosis of high-dose and extended involved field, intensity-modulated radiotherapy for patients with early stage nasal NK/T-cell lymphoma. Int J Radiat Oncol Biol Phys. 2012;82:1115–21.

    Article  PubMed  Google Scholar 

  20. Li YX, Wang H, Jin J, et al. Radiotherapy alone with curative intent in patients with stage I extranodal, nasal type NK/T-cell lymphoma. Int J Radiat Oncol Biol Phys. 2012;82:1809–15.

    Article  PubMed  Google Scholar 

  21. Chauchetad A, Michallet AS, Berger F, et al. Complete remission after first-line radio-chemotherapy as predictor of survival in extranodal NK/T-cell lymphoma. J Hematol Oncol. 2012;8:2–7.

    Google Scholar 

  22. Huang LI, Lin X, Cai Q, et al. Long-term outcome of patients with newly diagnosed natural-killer/T-cell lymphoma treated with etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin regimen. Leuk Lymphoma. 2011;52:1041–8.

    Article  PubMed  CAS  Google Scholar 

  23. Yamaguchi M, Tobinai K, Oguchima M, et al. Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma. J Clin Oncol. 2009;27:5594–600.

    Article  PubMed  CAS  Google Scholar 

  24. Kim SJ, Kim K, Kim BS, et al. Phase II trial of concurrent radiation and weekly cisplatin followed by VIPD chemotherapy in newly diagnosed stage IE to IIE, nasal, extranodal NK/T-cell lymphoma. J Clin Oncol. 2009;27:6027–32.

    Article  PubMed  CAS  Google Scholar 

  25. Shimada K, Suzuki R. Concurrent chemoradiotherapy for limited stage extranodal, natural killer/T-cell lymphoma, nasal type. J Clin Oncol. 2010;29:e239. (Letter).

    Google Scholar 

  26. Jaclard A, Cachard N, Marin B, et al. Efficacy of L-asparaginase with methotrexate and dexametasone (Asad-Met-Dex regimen) in patients with refractory or relapsing extranodal NK/T-cell lymphoma. Blood. 2011;117:1834–9.

    Article  Google Scholar 

  27. Yamaguchi M, Kuong YL, Kim KS, et al. Phase II trial of SMILE chemotherapy for newly diagnosed stage IV, relapsed or refractory extranodal natural killer/T-cell lymphoma, nasal type. J Clin Oncol. 2009;29:4410–6.

    Article  Google Scholar 

  28. Yong W, Zheng W, Zhu J, et al. L-asparaginase in the treatment of refractory and relapsed extranodal NK/T-cell lymphoma, nasal type. Ann Hematol. 2009;88:647–52.

    Article  PubMed  CAS  Google Scholar 

  29. Chan A, Tang T, Ne T, et al. To SMILE or not: supportive care matters. J Clin Oncol. 2012;30:1015–6. (Letter).

    Article  PubMed  Google Scholar 

  30. Kwong YL, Anderson BO, Advani R, Kim WS, Levine AM, Lin ST. Management of T-cell and natural-killer neoplasm in Asia. Lancet Oncol. 2009;10:1093–101.

    Article  PubMed  Google Scholar 

  31. Avilés A, Neri N, Fernandez R, Calva A, Huerta-Guzmán J, Nambo MJ. Nasal NK/T-cell lymphoma with disseminated disease treated with aggressive combined chemotherapy. Med Oncol. 2003;20:13–7.

    Article  PubMed  Google Scholar 

  32. Avilés A, Cleto S, Castañeda C, Nambo MJ. CMED in the treatment of nasal natural-killer T/-cell lymphoma with distant metastases. Hematology. 2007;12:241–4.

    Article  PubMed  Google Scholar 

  33. Cheson BD, Horning SJ, Coiffier B, et al. Report of an International Workshop to standardize response criteria for non-Hodgkin’s lymphoma. J Clin Oncol. 1999;17:1244–53.

    PubMed  CAS  Google Scholar 

  34. Ishida F, Nishina S, Asano N, et al. Late relapse of extranodal natural-killer/T-cell lymphoma alter more that 10 years. Leuk Lymphoma. 2010;51:171–3.

    Article  PubMed  Google Scholar 

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Acknowledgments

The present work did not receive any financial support and was performed with the owner resources of the Mexican Institute of Social Security.

Conflict of interest

All authors disclose no conflict of interest.

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Authors and Affiliations

  1. Oncology Research Unit, National Medical Center, Oncology Hospital, IMSS, Avenida Cuauthemoc 330, Colonia Doctores, 06700, Mexico, DF, Mexico

    Agustin Avilés

  2. Department of Hematology, National Medical Center, Oncology Hospital, IMSS, Mexico, DF, Mexico

    Natividad Neri, Judith Huerta-Guzmán & Maria-Jesus Nambo

  3. Department of Radiotherapy, National Medical Center, Oncology Hospital, IMSS, Mexico, DF, Mexico

    Raúl Fernández

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  1. Agustin Avilés
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  2. Natividad Neri
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  3. Raúl Fernández
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  4. Judith Huerta-Guzmán
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  5. Maria-Jesus Nambo
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Correspondence to Agustin Avilés.

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Avilés, A., Neri, N., Fernández, R. et al. Combined therapy in untreated patients improves outcome in Nasal NK/T lymphoma: results of a clinical trial. Med Oncol 30, 637 (2013). https://doi.org/10.1007/s12032-013-0637-1

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  • DOI: https://doi.org/10.1007/s12032-013-0637-1

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