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. 2018 Jan;18(1):e41-e50.
doi: 10.1016/j.clml.2017.10.001. Epub 2017 Oct 12.

Management of Advanced and Relapsed/Refractory Extranodal Natural Killer T-Cell Lymphoma: An Analysis of Stem Cell Transplantation and Chemotherapy Outcomes

Jonathan E Brammer  1 , Dai Chihara  2 , L Michelle Poon  3 , Paolo Caimi  4 , Marcos de Lima  4 , Celina Ledesma  5 , Gabriela Rondon  5 , Stefan O Ciurea  5 , Yago Nieto  5 , Michelle Fanale  2 , Bouthaina Dabaja  6 , Richard T Maziarz  7 , Richard E Champlin  5 , Chitra Hosing  5 , Yasuhiro Oki  2
Affiliations

Management of Advanced and Relapsed/Refractory Extranodal Natural Killer T-Cell Lymphoma: An Analysis of Stem Cell Transplantation and Chemotherapy Outcomes

Jonathan E Brammer et al. Clin Lymphoma Myeloma Leuk. 2018 Jan.

Abstract

Background: Extra-Nodal natural killer/T-cell lymphoma (ENKL) is a rare lymphoma representing approximately 5-10% of T-cell non-Hodgkin lymphomas diagnosed in the United States each year. Patients with advanced stage III/IV ENKL and relapsed refractory ENKL have a poor prognosis even despite aggressive therapy and stem cell transplantation (SCT). We conducted a review of the management of 37 patients with advanced-stage and relapsed/refractory ENKL in a predominantly non-Asian cohort evaluating both chemotherapy and SCT outcomes.

Patients and methods: We evaluated clinical outcomes in all patients treated for advanced stage III/IV or relapsed/refractory ENKL at MD Anderson cancer center between 2000-2014. Next, we collected stem cell transplant data from four transplant institutions to further evaluate outcomes of both allogeneic (allo-SCT) and autologous (auto-SCT) stem cell transplantation in ENKL.

Results: OS and PFS were 73% and 45% at one year, and 30% and 19% at 3-years, respectively. SMILE chemotherapy was more effective in maintaining a CR compared to CHOP (83% vs 17%). Only achievement of CR was prognostic for OS (HR 0.245, p=0.002) and PFS (HR 0.072, p) CONCLUSION: Our results suggest that achievement of a CR is imperative in patients with advanced ENKL, and is desirable for any patient for whom auto-SCT is utilized. SMILE-based chemotherapy appeared effective in attaining a CR, and was also an effective salvage regimen. For patients attaining a first CR, auto-SCT should be strongly considered, but should definitely be utilized in patients attaining CR2. For patients with refractory disease, allo-SCT can be considered in a selected group of patients.

Keywords: Extranodal natural killer/T-cell lymphoma; SMILE; advanced stage; refractory disease; stem cell transplant.

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Conflict of interest statement

Conflict of Interest: The authors have no conflict of interest to declare

Figures

Figure 1:
Figure 1:
OS for all Patients
Figure 2:
Figure 2:
PFS of Relapsed/Refractory Advanced ENKL Receiving Therapy (n=14)
Figure 3:
Figure 3:
Cumulative Incidence of Non-Relapse Mortality & Relapse Mortality for the Entire Cohort
Figure 4:
Figure 4:
Progression-Free Survival Between Autologous and Allogeneic Transplant
See this image and copyright information in PMC

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