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- Title
Management of Advanced and Relapsed/Refractory Extranodal Natural Killer T-Cell Lymphoma: An Analysis of Stem Cell Transplantation and Chemotherapy Outcomes.
- Authors
Brammer, Jonathan E.; Chihara, Dai; Poon, L. Michelle; Caimi, Paolo; de Lima, Marcos; Ledesma, Celina; Rondon, Gabriela; Ciurea, Stefan O.; Nieto, Yago; Fanale, Michelle; Dabaja, Bouthaina; Maziarz, Richard T.; Champlin, Richard E.; Hosing, Chitra; Oki, Yasuhiro
- Abstract
<bold>Background: </bold>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.<bold>Patients and Methods: </bold>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.<bold>Results: </bold>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.
- Subjects
LYMPHOMA treatment; STEM cell transplantation; ANTINEOPLASTIC agents; CANCER relapse; LONGITUDINAL method; LYMPHOMAS; PROGNOSIS; T cells; PHARMACODYNAMICS
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2018, Vol 18, Issue 1, pe41
- ISSN
2152-2650
- Publication type
journal article
- DOI
10.1016/j.clml.2017.10.001