Early disease progression in patients with localized natural killer/T‐cell lymphoma treated with concurrent chemoradiotherapy

Abstract

Prognosis of patients with localized nasal extranodal natural killer/T‐cell lymphoma, nasal type (ENKL) has been improved by non‐anthracycline‐containing treatments such as concurrent chemoradiotherapy (CCRT). However, some patients experience early disease progression. To clarify the clinical features and outcomes of these patients, data from 165 patients with localized nasal ENKL who were diagnosed between 2000 and 2013 at 31 institutes in Japan and who received radiotherapy with dexamethasone, etoposide, ifosfamide, and carboplatin (RT‐DeVIC) were retrospectively analyzed. Progression of disease within 2 years after diagnosis (POD24) was used as the definition of early progression. An independent dataset of 60 patients with localized nasal ENKL who received CCRT at Samsung Medical Center was used in the validation analysis. POD24 was documented in 23% of patients who received RT‐DeVIC and in 25% of patients in the validation cohort. Overall survival (OS) from risk‐defining events of the POD24 group was inferior to that of the reference group in both cohorts (P < .00001). In the RT‐DeVIC cohort, pretreatment elevated levels of serum soluble interleukin‐2 receptor (sIL‐2R), lactate dehydrogenase, C‐reactive protein, and detectable Epstein‐Barr virus DNA in peripheral blood were associated with POD24. In the validation cohort, no pretreatment clinical factor associated with POD24 was identified. Our study indicates that POD24 is a strong indicator of survival in localized ENKL, despite the different CCRT regimens adopted. In the treatment of localized nasal ENKL, POD24 is useful for identifying patients who have unmet medical needs.

Progression-free survival at 24 months and subsequent survival of patients with extranodal NK/T-cell lymphoma: a China Lymphoma Collaborative Group (CLCG) study

“…Regarding ENKTCL patients who failed to achieve PFS24, the median OS after progression was only 5.3 months, indicating that few patients who suffer early progression can be successfully treated. As observed by other studies [35,36], ENKTCL patients who suffer disease progression after initial treatment had extremely poor prognoses, regardless of stage or risk group. In a recent study of 179 patients with ENKTCL who suffered disease relapse or progression after initial non-ANT-based chemotherapy, the median OS was only 6.4 months [35].…”

“…As observed by other studies [35,36], ENKTCL patients who suffer disease progression after initial treatment had extremely poor prognoses, regardless of stage or risk group. In a recent study of 179 patients with ENKTCL who suffered disease relapse or progression after initial non-ANT-based chemotherapy, the median OS was only 6.4 months [35]. Similarly, for patients who failed to achieve PFS24 or EFS24, the subsequent median OS was 7.2 months after ANT-based immunochemotherapy for DLBCL and 4.9 months after ANT-based chemotherapy for PTCL [28,29].…”

Primary laryngeal T-cell lymphoma: A case report and review of the literature

“…The Ki-67 index ranged 30%–80% [ 3 ]. Authors suggested that the outcome of laryngeal T lymphoma was bleak, more than half of them (73.1%) died with earlier treatment either from tumor dissemination or severe laryngeal complications, such as bleeding or obstruction [ 5 , 14 ].…”

Treatment of localized extranodal NK/T cell lymphoma, nasal type: a systematic review

“…Recent studies comparing the outcomes of concurrent, sequential, and sandwich chemoradiotherapy have shown similar efficacy, although these were based on the results of retrospective and indirect comparisons [45, 46]. The long-term outcomes of patients receiving concurrent chemoradiotherapy regimens including DeVIC and VIDL in Japan and Korea were also similar [47]. Therefore, all these approaches may be recommended as a first-line treatment for localized nasal ENKTL.…”

“…For example, if patients relapse locally confined to nasal cavity without systemic symptoms and the time to relapse is longer than at least 2 years, retreatment with concurrent or sequential or sandwich chemoradiotherapy may be tried, as for newly diagnosed patients. However, if disease relapse occurs within 2 years after the completion of first-line treatment, systemic chemotherapy should be considered because the outcome of early disease relapse was found to be poor in a recent retrospective study of patients with localized nasal ENKTL receiving concurrent chemoradiotherapy [47].…”