A prognostic index for natural killer cell lymphoma after non-anthracycline-based treatment: a multicentre, retrospective analysis

Kim, Seok Jin; Yoon, Dok Hyun; Jaccard, Arnaud; Chng, Wee Joo; Lim, Soon Thye; Hong, Huangming; Park, Yong; Chang, Kian Meng; Maeda, Yoshinobu; Ishida, Fumihiro; Shin, Dong Yeop; Kim, Jin Seok; Jeong, Seong Hyun; Yang, Deok Hwan; Jo, Jae Cheol; Lee, Gyeong Won; Choi, Chul Won; Lee, Won Sik; Chen, Tsai Yun; Kim, Kiyeun; Jung, Sin Ho; Murayama, Tohru; Oki, Yasuhiro; Advani, Ranjana H.; d’Amore, Francesco; Schmitz, Norbert; Suh, Cheolwon; Suzuki, Ritsuro; Kwong, Yok Lam; Lin, Tong; Kim, Won Seog

doi:10.1016/s1470-2045(15)00533-1

Cited by 300 publications

(344 citation statements)

References 26 publications

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“…Recently we proposed both PINK and PINK-E as prognostic models of ENKTL in nonanthracycline-based treatment [11]. However, PINK must have a limitation in discriminating prognosis in this early-stage nasal-type disease because all the patients have stage 1 or 2 disease, nasal involvement, and no distant lymph node involvement therefore leaving just age as a valid variable for this model.…”

Section: Discussionmentioning

confidence: 99%

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Phase II trial of concurrent chemoradiotherapy with L-asparaginase and MIDLE chemotherapy for newly diagnosed stage I/II extranodal NK/T-cell lymphoma, nasal type (CISL-1008)

et al. 2016

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We designed a new treatment protocol incorporating concurrent administration of L-asparaginase (to reduce the probability of systemic progression during concurrent chemoradiotherapy (CCRT)) plus high-dose methotrexate to consolidation chemotherapy to intensify the regimen for treating localized extranodal NK/T cell lymphoma, nasal type (ENKTL). CCRT comprised radiation (36–44 Gy) with weekly cisplatin (30 mg/m2) and tri-weekly L-asparaginase (4 000 IU). Chemotherapy—MIDLE (methotrexate 3 g/m2 on day 1, etoposide 100 mg/m2 and Ifosfamide 1 000 mg/m2 on days 2–3, dexamethasone 40 mg on days 1–4, and L-asparaginase 6 000 IU/m2 on days 4, 6, 8, 10)—was repeated every 28 days for two cycles. One of the 28 patients developed distant lesions after CCRT. The final complete response rate was 82.1%. Four patients dropped out during or after their first MIDLE cycle due to toxicities (recurrent G3 hyperbilirubinemia [n = 1], G3-5 increased creatinine [n = 2], and G5 infection [n = 1]). With a median follow-up of 46 months (95% CI: 39–47 months), the estimated 3-year progression-free survival rate and overall survival rate were 74.1% and 81.5%, respectively. This MIDLE protocol may be effective for localized ENKTL. However, concurrent administration of L-asparaginase during CCRT does not seem to provide additional benefits.

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Section: Discussionmentioning

confidence: 99%

“…For prognostic factor analysis, prognostic index for NK/T cell lymphoma-EBV (PINK-E) was evaluated [11]. Quantitative polymerase chain reaction of EBV DNA in the peripheral blood was also performed as proposed previously [13, 14].…”

Section: Methodsmentioning

confidence: 99%

Phase II trial of concurrent chemoradiotherapy with L-asparaginase and MIDLE chemotherapy for newly diagnosed stage I/II extranodal NK/T-cell lymphoma, nasal type (CISL-1008)

et al. 2016

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“…17 In a retrospective analysis of 527 patients aged >60 years, stage III or IV disease, distant lymph node involvement, and non-nasal-type disease were identified as predictors of OS and progression-free survival (PFS). 17 The NCCN Guidelines recommend measurement of EBV-DNA load and calculation prognostic index (PINK or PINK-E) as part of initial workup.…”

Section: <10mentioning

confidence: 99%

NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018

Horwitz

Ansell

et al. 2018

J Natl Compr Canc Netw

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Natural killer (NK)/T-cell lymphomas are a rare and distinct subtype of non-Hodgkin's lymphomas. NK/T-cell lymphomas are predominantly extranodal and most of these are nasal type, often localized to the upper aerodigestive tract. Because extranodal NK/T-cell lymphomas (ENKL) are rare malignancies, randomized trials comparing different regimens have not been conducted to date and standard therapy has not yet been established for these patients. These NCCN Guidelines Insights discuss the recommendations for the diagnosis and management of patients with ENKL as outlined in the NCCN Guidelines for T-Cell Lymphomas.

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“…Kim et al recently proposed the following two new prognostic models: the prognostic index of natural killer lymphoma (PINK) and the PINK plus Epstein-Barr virus DNA (PINK-E) for patients with ENKTL received non-anthracycline-based treatment [23]. The PINK identified 3 risk groups (low risk: no risk factors, intermediate-risk: one risk factor, and high-risk: two or more risk factors) with different survival outcomes based on the presence or absence of 4 prognostic factors (age greater than 60 years, stage III or IV disease, distant lymph-node involvement, and non-nasal type disease).…”

Section: Resultsmentioning

confidence: 99%

Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type

et al. 2016

Oncotarget

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Objectives: The role of body mass index (BMI) in lymphoma survival outcomes is controversial. The prognostic significance of BMI in extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is unclear. We evaluated the prognostic role of BMI in patients with ENKTL.Methods: We retrospectively analyzed 742 patients with newly diagnosed ENKTL. The prognostic value of BMI was compared between patients with low BMIs (< 20.0 kg/m2) and patients with high BMIs (≥ 20.0 kg/m2). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) was also evaluated and compared with that of the BMI classification.Results: Patients with low BMIs tended to exhibit higher Eastern Cooperative Oncology Group performance status (ECOG PS) scores (≥ 2) (P = 0.001), more frequent B symptoms (P < 0.001), lower albumin levels (P < 0.001), higher KPI scores (P = 0.03), and lower rates of complete remission (P < 0.001) than patients with high BMIs, as well as inferior progression-free survival (PFS, P = 0.003), and inferior overall survival (OS, P = 0.001). Multivariate analysis demonstrated that age > 60 years, mass > 5 cm, stage III/IV, elevated LDH levels, albumin levels < 35 g/L and low BMIs were independent adverse predictors of OS. The BMI classification was found to be superior to the IPI with respect to predicting patient outcomes among low-risk patients and the KPI with respect to distinguishing between intermediate-low- and high-intermediate-risk patients.Conclusions: Higher BMI at the time of diagnosis is associated with improved overall survival in ENKTL. Using the BMI classification may improve the IPI and KPI prognostic models.

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A prognostic index for natural killer cell lymphoma after non-anthracycline-based treatment: a multicentre, retrospective analysis

Cited by 300 publications

References 26 publications

Phase II trial of concurrent chemoradiotherapy with L-asparaginase and MIDLE chemotherapy for newly diagnosed stage I/II extranodal NK/T-cell lymphoma, nasal type (CISL-1008)

Phase II trial of concurrent chemoradiotherapy with L-asparaginase and MIDLE chemotherapy for newly diagnosed stage I/II extranodal NK/T-cell lymphoma, nasal type (CISL-1008)

NCCN Guidelines Insights: T-Cell Lymphomas, Version 2.2018

Increased body mass index is associated with improved overall survival in extranodal natural killer/T-cell lymphoma, nasal type

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