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DOI: 10.4103/ijmpo.ijmpo_60_17
Combined Modality Treatment with “Dexamethasone, Methotrexate, Ifosfamide, L-Asparaginase, and Etoposide ” Chemotherapy and Involved Field Radiotherapy for Early Stage Natural Killer/T Cell Lymphoma with Local Tumor Invasiveness: A Single-institution Study from India
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Abstract
Context: Patients with early stage extranodal natural killer/T-cell lymphoma, nasal type (ES-NKTCL) and local tumor invasiveness (LTI) show poor treatment outcomes with standard approaches. Dexamethasone, methotrexate, ifosfamide, L-asparaginase, and etoposide (SMILE) is an intensive, highly active protocol mainly studied in advanced/recurrent disease. No prior study has utilized this protocol in high-risk ES-NKTCL. Methods: Between 2011 and 2016, all patients with ES-NKTCL with LTI at presentation were uniformly treated at our institute with a combination of SMILE chemotherapy for 5–6 cycles, and involved-field radiotherapy (IFRT). Records of these patients were retrospectively reviewed. Results: Sixteen patients were identified, 69% stage IE and 31% stage IIE. The majority of patients had B-symptoms (75%), paranasal sinus (PNS) invasion (81%), facial skin invasion (56%), palatal perforation (69%), or orbital extension (56%). 12/16 had B-symptoms, and 6/16 had elevated lactate dehydrogenase. All patients received the entire planned 5–6 cycles. IFRT was delivered after a mean 4 cycles. Complete remission was achieved in 13/15 (87%) patients. At a median follow up of 18.5 months, 1-year progression-free survival and overall survival was 84% and 94%, respectively. Grade 3–4 toxicity was seen in 81%, most commonly neutropenia (75%), anemia (44%), and thromobocytopenia (31%). Six patients required dose adjustments (predominantly in the first 1 or 2 cycles). No treatment-related mortality was noted. Conclusion: SMILE with RT is a toxic but tolerable protocol for ES-NKTCL with LTI with high efficacy. Prospective studies are warranted.
Publikationsverlauf
Artikel online veröffentlicht:
23. Juni 2021
© 2018. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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References
- 1 Liang X, Graham DK. Natural killer cell neoplasms. Cancer 2008; 112: 1425-36
- 2 Tse E, Kwong YL. How I treat NK/T-cell lymphomas. Blood 2013; 121: 4997-5005
- 3 Yang Y, Zhu Y, Cao JZ, Zhang YJ, Xu LM, Yuan ZY. et al. Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: Analysis from a multicenter study. Blood 2015; 126: 1424-32
- 4 Bi XW, Zhang WW, Li ZM, Huang JJ, Xia Y, Sun P. et al. The extent of local tumor invasion predicts prognosis in stage IE nasal natural killer/T-cell lymphoma: A novel T staging system for risk stratification. Ann Hematol 2015; 94: 1515-24
- 5 Yang Y, Zhang YJ, Zhu Y, Cao JZ, Yuan ZY, Xu LM. et al. Prognostic nomogram for overall survival in previously untreated patients with extranodal NK/T-cell lymphoma, nasal-type: A multicenter study. Leukemia 2015; 29: 1571-7
- 6 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
- 7 Kim JY, Lee SW, Lee JH, Suh C, Yoon DH, Lee BJ. et al. 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
- 8 Na II, Kang HJ, Park YH, Lee SS, Yoo HJ, Choe DH. et al. Prognostic factors for classifying extranodal NK/T cell lymphoma, nasal type, as lymphoid neoplasia. Eur J Haematol 2007; 79: 1-7
- 9 Li YX, Yao B, Jin J, Wang WH, Liu YP, Song YW. et al. Radiotherapy as primary treatment for stage IE and IIE nasal natural killer/T-cell lymphoma. J Clin Oncol 2006; 24: 181-9
- 10 Kim TM, Park YH, Lee SY, Kim JH, Kim DW, Im SA. et al. Local tumor invasiveness is more predictive of survival than International Prognostic Index in stage I(E)/II(E) extranodal NK/T-cell lymphoma, nasal type. Blood 2005; 106: 3785-90
- 11 You JY, Chi KH, Yang MH, Chen CC, Ho CH, Chau WK. et al. Radiation therapy versus chemotherapy as initial treatment for localized nasal natural killer (NK)/T-cell lymphoma: A single institute survey in Taiwan. Ann Oncol 2004; 15: 618-25
- 12 Li YX, Coucke PA, Li JY, Gu DZ, Liu XF, Zhou LQ. et al. Primary non-Hodgkin's lymphoma of the nasal cavity: Prognostic significance of paranasal extension and the role of radiotherapy and chemotherapy. Cancer 1998; 83: 449-56
- 13 Robbins KT, Fuller LM, Vlasak M, Osborne B, Jing BS, Velasquez WS. et al. Primary lymphomas of the nasal cavity and paranasal sinuses. Cancer 1985; 56: 814-9
- 14 Lee J, Suh C, Park YH, Ko YH, Bang SM, Lee JH. et al. Extranodal natural killer T-cell lymphoma, nasal-type: A prognostic model from a retrospective multicenter study. J Clin Oncol 2006; 24: 612-8
- 15 Logsdon MD, Ha CS, Kavadi VS, Cabanillas F, Hess MA, Cox JD. Lymphoma of the nasal cavity and paranasal sinuses: Improved outcome and altered prognostic factors with combined modality therapy. Cancer 1997; 80: 477-88
- 16 Kim TM, Heo DS. Extranodal NK/T-cell lymphoma, nasal type: New staging system and treatment strategies. Cancer Sci 2009; 100: 2242-8
- 17 Yamaguchi M, Kita K, Miwa H, Nishii K, Oka K, Ohno T. et al. Frequent expression of P-glycoprotein/MDR1 by nasal T-cell lymphoma cells. Cancer 1995; 76: 2351-6
- 18 Wang L, Wang ZH, Chen XQ, Li YJ, Wang KF, Xia YF. et al. 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 2013; 119: 348-55
- 19 Jiang M, Zhang H, Jiang Y, Yang Q, Xie L, Liu W. et al. Phase 2 trial of “sandwich” L-asparaginase, vincristine, and prednisone chemotherapy with radiotherapy in newly diagnosed, stage IE to IIE, nasal type, extranodal natural killer/T-cell lymphoma. Cancer 2012; 118: 3294-301
- 20 Yamaguchi M, Kwong YL, Kim WS, Maeda Y, Hashimoto C, Suh C. et al. Phase II study of SMILE chemotherapy for newly diagnosed stage IV, relapsed, or refractory extranodal natural killer (NK)/T-cell lymphoma, nasal type: The NK-Cell Tumor Study Group study. J Clin Oncol 2011; 29: 4410-6
- 21 Li X, Cui Y, Sun Z, Zhang L, Li L, Wang X. et al. DDGP versus SMILE in newly diagnosed advanced natural Killer/T-Cell lymphoma: A randomized controlled, multicenter, open-label study in China. Clin Cancer Res 2016; 22: 5223-8
- 22 Kwong YL, Kim WS, Lim ST, Kim SJ, Tang T, Tse E. et al. SMILE for natural killer/T-cell lymphoma: Analysis of safety and efficacy from the Asia Lymphoma Study Group. Blood 2012; 120: 2973-80
- 23 Chan A, Tang T, Ng T, Shih V, Tay K, Tao M. et al. To SMILE or not: Supportive care matters. J Clin Oncol 2012; 30: 1015-6
- 24 Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y. et al. Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol 2009; 27: 5594-600
- 25 Kim SJ, Kim K, Kim BS, Kim CY, Suh C, Huh J. 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: Consortium for Improving Survival of Lymphoma study. J Clin Oncol 2009; 27: 6027-32
- 26 Kwong YL. Natural killer-cell malignancies: Diagnosis and treatment. Leukemia 2005; 19: 2186-94
- 27 Gupta VG, Gogia A. DDGP versus SMILE in NK/T-Cell Lymphoma-Letter. Clin Cancer Res 2016; 22: 4271