CHOP followed by involved field radiation: Is it optimal for localized nasal natural killer/T-cell lymphoma?

Abstract

The present study aimed to analyse the treatment outcome of four cycles of CHOP (cyclophosphamide-vincristine-doxorubicin-prednisolone) followed by involved field radiation therapy (IF RT) for the treatment of stage I-II nasal natural killer (NK)/T-cell lymphoma. From March 1995 to December 1999, 17 patients (median age 41 years; range 30-66) with localized nasal NK/T-cell lymphoma were enrolled. B symptoms were noted in five patients (31%). Sixteen of seventeen patients (94%) were of low risk when classified according to the International Prognostic Index (IPI). The treatment plan consisted of four cycles of CHOP chemotherapy followed by IF RT of 45 Gy. Two patients received radiation during the first or second cycle of CHOP because of bleeding from the primary tumour site. Both patients achieved complete responses (CRs). In the remaining 15 patients, after 4 cycles of CHOP, 6 CRs and 3 partial responses (PRs) were achieved (53% of response rate). IF RT was given to six patients (four in CR, one in PR and one in PD), and all six patients achieved CR. Overall, CR was achieved in 10 of 17 patients (58%). The planned sequential chemoradiotherapy was completed in only 6 of 17 patients (35%) because of the progression during chemotherapy. None of the patients who achieved CR experienced relapse of lymphoma during follow-up. The estimated overall three-year survival rate was 59%. In univariate analysis, B symptoms and stage were significant prognostic factors for response and overall survival (P < 0.05). The present study suggests that four cycles of CHOP followed by IF RT is not satisfactory for treating patients with localized nasal NK/T-cell lymphoma, and that further exploration for improved therapy is needed.

NK/T Cell Lymphoma: A Tertiary Centre Experience

“…Congruent with other studies, standard anthracycline based chemotherapy was ineffective in 3 out of 4 patients progressing on CHOP in this present series [10]. The median PFS following therapy with CHOP was 4.5 months (range 2-34 months).…”

High-dose chemotherapy with autologous stem cell transplantation in extranodal NK/T-cell lymphoma: a retrospective comparison with non-transplantation cases

“…However, the efficacy of combined modalities of chemotherapy and radiotherapy has been disappointing. 6 Furthermore, it has been suggested by several groups including ours that patients with extra-upper aerodigestive tract (EUNKTL) had poorer prognosis to conventional anthracycline-based chemotherapy. 7,8 Few reports have demonstrated promising results with highdose chemotherapy and autologous stem cell transplantation (HDC/ASCT) in NK/T-cell lymphoma patients as a salvage treatment.…”

Current and future management of NK/T-cell lymphoma based on clinical trials

“…Researchers in Samsung Medical Center in Korea conducted two single-institution clinical studies of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) followed by RT for stage IE or non-bulky stage IIE nasal NKTCL and reported the results [30,31]. First, they treated 17 patients between March 1995 and December 1999.…”

“…The CR rate was 58 %. The planned combined modality therapy could only be completed in six patients due to early disease progression during the chemotherapy phase [30]. Next, 17 patients were treated with two cycles of dose-intensified CHOP14 (the doses of cyclophosphamide and doxorubicin were escalated to 1,250 and 75 mg/m 2 , respectively) followed by IF-RT (44 Gy), and an additional four cycles of standard CHOP from March 2000 to June 2004.…”