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. 2020 Dec;61(14):3331-3341.
doi: 10.1080/10428194.2020.1811864. Epub 2020 Aug 26.

Modified SMILE (mSMILE) and intensity-modulated radiotherapy (IMRT) for extranodal NK-T lymphoma nasal type in a single-center population

Paola Ghione  1 , Shunan Qi  2   3 , Brandon S Imber  2 , Venkatraman Seshan  4 , Alison Moskowitz  1 , Natasha Galasso  1 , Matthew Lunning  1 , David Straus  1 , Craig Sauter  5 , Parastoo Dahi  5 , Ahmet Dogan  6 , Joachim Yahalom  2 , Steven Horwitz  1
Affiliations

Modified SMILE (mSMILE) and intensity-modulated radiotherapy (IMRT) for extranodal NK-T lymphoma nasal type in a single-center population

Paola Ghione et al. Leuk Lymphoma. 2020 Dec.

Abstract

A modification of the SMILE regimen with dexamethasone, methotrexate, ifosfamide, L-asparaginase, etoposide (mSMILE) followed by Intensity-Modulated Radiotherapy (IMRT) at lower than usual dose, has been adopted as standard of care for extranodal NK-/T-cell lymphoma (ENKL) at our institution. mSMILE is a short course, intensive regimen incorporating pegylated asparaginase. Here, we describe clinical details, outcome and safety of patients receiving mSMILE. Among 28 patients with ENKL treated, response post-mSMILE was 93% (CR 68%), response post IMRT was 95% (CR 87.5%). Among early-stage patients/low PINK-E (n = 13), overall survival (OS) was 100% at the median follow-up of 31 months; progression-free survival (PFS) was 92%. Advanced-stage and intermediate/high PINK-E patients fared similarly (OS 43%, PFS 33.3% at the median follow-up). Thirty-two percent of the patients experienced G3-4 non-hematologic toxicity, all experienced hematologic toxicity. Most localized-stage patients achieved long-term disease control. Despite high response rates, most of the advanced stage patients relapsed quickly.

Keywords: Lymphocytes; NK cell biology; NK-T cell lymphoma; asparaginase; mSMILE.

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Figures

Figure 1.
Figure 1.
Example of IMRT treatment fields for localized and locally-advanced cases.
Figure 2.
Figure 2.
Overall survival (OS) and progression free survival (PFS) of the population treated with mSMILE. Panels A and B: OS and PFS of the whole population. Panels C and D: OS and PFS of localized vs advanced stage population.
Figure 3.
Figure 3.
Progression free survival (PFS) of localized stage disease with Ann Arbor staging versus Asian staging.
Figure 4.
Figure 4.
OS and PFS with the new prognostic scores PINK and PINK-E
Figure 5.
Figure 5.
Detail of the study population.
See this image and copyright information in PMC

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